January is for addictions – food, exercise, sugar, drugs, work, alcohol, tobacco, bread, gluten, illness … they all end up affecting the same place in our brains, all seemingly leading to pleasure initially – the dopamine rush – followed by eventual heartbreak.
We will discuss the mechanisms in the brain that lead us into addiction, and look for some of the pathways that lead out of addiction into true pleasure.
In 2002, Sherry Rogers, MD published a book entitled: Detoxify or Die[i], in which she discussed the toxic effect of things we are exposed to on a daily basis - chemicals in our food, pollution in our air, toxic chemicals in our cosmetics, soaps and lotions, artificial sweeteners in our drinks.
As any good cook knows, it is very difficult to cook a meal in a kitchen full of dirty dishes and last night's food scraps. The first thing a cook does is clean up the kitchen.
By the same token, in order to get healthy, the first thing we have to do is get rid of the toxins in our bodies so that we can build health on a clean foundation.
That's not so easy in today's world. Even newborn babies have over 200 toxic chemicals in their blood, from the moment they first come in to this world.[ii]
Most of us do not have much control over the air we breathe (unless we choose to use chemical "air fresheners") or the water we drink (unless we choose to drink bottled water from toxic plastic bottles). But we certainly do have control over toxic chemicals which we may put into our bodies.
Remember the old catch phrase: "The devil made me do it"? Like Geraldine's boyfriend, we often choose to deny responsibility for our actions. We smoke because we like the taste. We drink alcohol to excess because we like the taste. We eat sweets, and ice cream, and bread, and pasta because we like the taste. We use cocaine, or heroin, or barbiturates or methamphetamine because we like the taste, or the effect, or the high.
We fool ourselves into thinking that we can stop any time we want, we just don't want to stop just now.
And in the meantime, we smell and taste like the inside of a used ashtray, or a distillery. We get into car accidents and make poor judgment calls in our personal, and eventually in our professional lives. We outgrow our clothes, and sometimes even our furniture. We become diabetic, or get high blood pressure, or high cholesterol, or heart disease. We shoot ourselves up with Fentanyl in the operating room, and lose our jobs (and occasionally our patients). Our home lives are disrupted, we spend all our available money on our drug of choice - whether it be nicotine or alcohol or carbohydrates or pharmaceuticals, legal or illegal.
We do in fact have control over what goes into our mouths, we just have to choose to exercise that control. So why is it so very difficult for us to exercise that vaunted control?
In a 1998 paper entitled A conceptual framework for explaining drug addiction we read that drug addiction "is best defined by repeated failures to refrain from drug use despite prior resolutions to do so. This definition is consistent with views of addiction that see decision-making, ambivalence and conflict as central features of the addict’s behavior and experience."[iii]
Are all addictions alike? There is "compelling evidence for the similarities between different types of addictions, notably substance-related addictions and Internet and gaming addiction. On the molecular level, Internet addiction is characterized by an overall reward deficiency that entails decreased dopaminergic activity. On the level of neural circuitry, Internet and gaming addiction led to neuroadaptation and structural changes that occur as a consequence of prolonged increased activity in brain areas associated with addiction. On a behavioral level, Internet and gaming addicts appear to be constricted with regards to their cognitive functioning in various domains."[iv]
In other words, addicts tend to have deficiencies of dopamine (the "pleasure-related neurotransmitter in the brain). They develop neural pathways that reinforce the behavior, as well as a mind-set characterized by denial (I can stop any time I want, I just don't choose to want right now.). If I give up carbohydrates, what in the world is left to eat? How am I going to stop losing weight? I am always hungry...
And like any habit, the more we do something, the easier it is to continue to do that something, and the more quickly we are tempted to resume the habit after abstinence, as any smoker will attest. "...nicotine dependence develops through a set sequence of symptoms in all smokers, and that the latency to withdrawal, the time it takes for withdrawal symptoms to appear during abstinence, is initially very long but shortens by several orders of magnitude over time."[v], [vi]
Addictive behavior involves administration of the substance even when the pleasure response is no longer in play. With addiction, there is initial pleasure response. This is followed by tolerance to the pleasure response, and finally adverse response. The compulsion to administer the drug or experience the effect of the situation is present despite the ill effects which the addict knows will follow. It is postulated that the addictive behavior and intermittent dopamine stimulation secondary to chronic intermittent stimuli leads to disruption of the orbito-frontal cortex by another circuit involved in regulating drive, by means of both "conscious (craving, loss of control, preoccupation with the addictive substance or experience) and unconscious (conditioned expectation, compulsivity, impulsivity, obsessiveness) processes." [vii]
Addiction has finally been recognized by at least some in the medical profession as a chronic neurologic disease. Disease implies the possibility of treatment and cure (although we in the medical profession are not allowed to use the word cure, or to promise cure of any "manifestly incurable" condition , under penalty of being charged with professional misconduct[viii]).
"Substance dependence/addiction, involving both a common brain reward mechanism and longer-lasting molecular and cellular changes, is a preventable chronic, relapsing brain disease... "[ix]
Is addiction limited only to alcohol, tobacco and drugs? It would be much easier to despise the addict, if this were so. Unfortunately, it does appear that any compulsive behavior causes the same dependency changes in the brain.
- food addiction - to fat[x], to sugar[xi], to artificial sweeteners[xii]
- Binge eating, for instance - "Subjects experiencing binge eating describe it as a loss of control during an over-consumption of food, which leads to an uncomfortable fullness and intense feelings of disgust and embarrassment (Stein et al. 2007). Binge eating disorder often occurs in co-morbidity with several diseases such as obesity, diabetes, cardiovascular diseases... Naltrexone, when administered systemically ... reduced ... responding for food and motivation to eat..."[xiii] Naltrexone is commonly used in high dose in Emergency Medicine to bring opiate addicts out of a potentially lethal overdose.
- compulsive buying[xiv],[xv] – "activation of distinct neural circuits related to anticipatory affect precedes and supports consumers' purchasing decisions."[xvi]
- Internet addiction – "On the molecular level, Internet addiction is characterized by an overall reward deficiency that entails decreased dopaminergic activity. On the level of neural circuitry, Internet and gaming addiction led to neuroadaptation and structural changes that occur as a consequence of prolonged increased activity in brain areas associated with addiction."[xvii]
- work addiction - to the point of destruction of family life and other pursuits[xviii], described as "compulsive behaviour that has negative consequences on ... mental and physical health, ... social and familial relationships and finally, ... work performance itself"
Early life trauma - e.g. separation from the mother - has been shown (in rats) to affect the dopamine receptors in adolescence, resulting in "microcircuitry-specific changes caused by early life adversity that could help explain heightened vulnerability to drug addiction during adolescence."[xix]
So... do we chalk it all up to early life trauma? The devil made me do it? I can't help myself, it's my personality? Which came first, the brain changes? Or the addiction? The chicken? Or the egg?[xx]
Much of our personality traits reside in our brains, whose basic function is to keep us alive through remembering experience and incorporating those memories into future actions. The orbito-frontal cortex of the brain contains the secondary taste cortex, representing the "reward value" of taste, as well as the areas relating to smell. Smell is one of the most powerful stimuli of memory, which is a major factor in addictive behavior. These areas are activated by both pleasant and painful stimuli, thus are able to help us predict whether our response to a similar stimulus should be "yes" or "no, run away".[xxi]
Does chemical sensitivity also trigger the structural-emotional-experiential loop the way taste can trigger the orbito-frontal cortex? A body loop is described, in which some previously categorized experience (taste, for example) has been associated with the situation in which the taste was experienced, and the emotions associated with that experience as well - It is thought that the ventro-medial prefrontal cortex establishes a link between past experience of a stimulus and past emotions associated with that experience.[xxii]
What is the essential difference between response to experience and the addiction response?
"addictive disorders reflect a dysregulation of the ability to evaluate potential reward against harm from drug self-administration"[xxiii] Components of addiction are (1) expectancy, based on probability of reward (2) compulsive drive, linked to craving and (3) decision making based on motivation and balance between expectation of immediate reward and possibility of long-term loss. The addict has poor decision-making skills, because craving overrides common sense.
So, did the devil in fact make us do it? Or do we have some control over our actions?
Those of us who have experienced addictive behavior realize full well that we have lost any control over our actions that we might once have had. But it is not until we actually admit that we have no control that we have even the possibility of regaining control.
We are capable of admitting that we
- have an addiction (step 1 of the 12-step groups),
- are powerless over the addiction by ourselves (step 2)
- realize that there is a "higher power" that can help us overcome the addiction and life our lives again (step 3)
In the 12-step groups, that "higher power" can be almost any external source of aid. The groups choose to call the higher power God. The 12-step groups generally recommend that a newbie get a sponsor - someone who has already trodden the path, and who can help to show the way.
We all need a light to shine in the darkness, to illumine our path, until we ourselves become an offshoot of that Light.
So, practically speaking, how do we get help?
At the Arizona Center for Advanced Medicine, we have many tools to serve as sources of light:
- Acupuncture to help with smoking cessation, alcohol and other addictions - since almost all addictions involve the sensation of taste and smell, and operate in the same orbito-frontal cortex areas of the brain, we use the standard NADA ear acupuncture points, among other treatments.
- Nutritional counseling for assistance with getting rid of the carbohydrates and other toxins in our diet
- Biophotonic therapy to help neutralize the effect of old experience which is still dictating our responses in the present
- Guided imagery and hypnosis to detoxify and eliminate old compulsions
- IV nutritional therapy to fill in the potholes in our nutritional status, so that we may move forward into our new lives
In the world of allopathic medicine, we read that "patients with multiple addictions require comprehensive assessment and acute treatment in the form of detoxification by appropriate medications in proper settings followed by long-term maintenance treatment for preventing relapses. It has been reported that when maintenance treatment is discontinued, addiction, like other chronic illnesses, worsens."[xxiv]
Our aim is to help our patients regain control over their lives, and to serve as a reference source for future health-related issues.
We do not generally use pharmaceutical medications to treat addictions, but we certainly do use supplements as a temporary measure, to help restore balance to the system during ongoing treatment.
Our aim is to empower our patients to regain their health, and to move on with their lives.