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Addictions and 'The Reward Pathway'
#1
Just in case, I thought some people might be interested in some of the papers I was writing for school. This might actually begin to touch on dreaming some time down the road, but for now, it's more oriented to brain chemistry and addictions. This was just a discussion question, so it's not chock full of statistical research. If you or someone you know is addicted, they MIGHT benefit from this brief discussion.





Having grown up in an alcoholic family, causation has always been on the forefront of my mind. That is, what exactly causes people to become addicted to substances, arousal, or repetitive behaviors? Certainly, I couldn’t possibly answer that broad and complex question in this format, but I think one of the most fundamental aspects of addiction causality is this concept called, “the reward pathway.”



In the Beginning…

The main premise behind the reward pathway is that there are actual physical and chemical processes in the brain that, at a minimum, could exacerbate one’s risk of becoming and staying addicted. We begin our tour inside the limbic system, which, among many other important functions, is well known for its role in human emotion. The reward pathway is said to begin in the Ventral Tegmental Area (VTA), which is physically located near the top of the brain stem. This is one of the few locations in the human brain where dopamine apparently originates. D2 (dopamine) is the main ingredient for those “high” feelings and pleasurable sensations (e.g., an orgasm).

The neurons in the VTA have axons that extend into the Nucleus Accumbens, and so we thus have the first portion of our reward pathway fully connected. The dopamine neurotransmitter fires up in the brain stem (VTA) and gets excreted to the receptor sites in the Nucleus Accumbens. The reason this is important is because we now have our first potential cause for addiction: “Many people who, for a genetic error, have a reduction of D2 (dopamine) receptors in the accumbens nucleus, become, sooner or later, incapable to obtain gratification from the common pleasures of life” (Rocha do Amral & Martins de Oliveira, n.d.),

In laymen’s terms, the pre-addicted person, for one of numerous possible reasons, is incapable of producing the necessary ingredients to ‘feel really good.’ This makes them vulnerable to substances that artificially boost D2 levels. For example, cocaine blocks the re-uptake of D2 and thus artificially increases the concentration of said neurotransmitter in the synaptic cleft. As an aside, the action of prohibiting re-uptake is precisely what is done in many of today’s anti-psychotic pharmaceuticals. This reaction is important for the reward pathway, especially when talking about tolerance.

Tolerance

More specifically, the body reacts to the increased dopamine concentrations by trimming its authentic production of it. So, even though the dopamine felt good, the body attempts to return itself to balance, and thus begins tailoring back its D2 production (even though it knows that reduced dopamine will not feel nearly as good—the body is seeking balance!) Thus, it now requires more cocaine to get the same D2 concentrations in the synaptic cleft. This would also explain why SSRIs and other re-uptake drugs can become ineffective or even dangerous in the long term.

My somewhat informal discussion of tolerance was a bit simplistic, for there are a couple of more scientific processes that are happening here: metabolic and functional. “Metabolic tolerance occurs when the body becomes so adapted to the presence of a drug that a given amount of the substance will produce less of an effect than when the user first tried the drug” (Derby, n.d.). In other words, the body begins adapting to the chemical by adjusting its numerous biological processes, which might include extorting the liver to produce more of a certain enzyme to ‘eat up’ the ingested toxin. On the other hand, pharmacodynamics (or functional) tolerance exists more in the neuron itself. Transmitters and receptors will exhibit morphed behaviors based on the dynamics incurred by the ingested toxin. Again, these processes are a direct result of the body’s broader homeostasis mechanisms.

Before we move on to the last component in the reward pathway, it is important to note that despite psychiatry’s incessant rebuke of natural cures, there are, indeed, other more natural ways to increase the various neurotransmitter in the human body. For example, “Tryptophan is the amino acid precursor for serotonin; phenylalanine and tyrosine are precursors for dopamine and norepinephrine” (Marohn, 2011, p. 40). So, instead of unnaturally closing off re-uptake channels to artificially boost certain ‘feel good’ neurotransmitters, it is possible to naturally increase neurotransmitter production through the use amino acid supplementation (‘production’ is highlighted because in this modality, one is not artificially boosting the neurotransmitter but rather giving the body the natural precursors to help the brain create its own neurotransmitter). However, I haven’t been able to find any studies on the efficacy of using this approach specifically with substance addictions. One reasonable hypothesis, especially with the lack of harmful side effects, is that if amino acids can all-out cure severe psychiatric mood disorders, it might be able to do the same for psychological woes in addicted patients.

Don't Forget About the Prefrontal Cortex

The last component of the reward pathway is the prefrontal cortex. This area is critical for several reasons. First, while the addict is intoxicated or ‘high,’ this cortex area is directly impacted, and so the affected person might experience degraded coordination and memory. Secondly, the substance can actually affect the person’s ability to learn, both in the intoxicated state and the withdrawal state. In fact, the dynamics happening in this area could very well explain why addicts and alcoholics have such a loss of control. In 2008, Yin published a possible connection between drug addiction and brain plasticity (or the person’s ability to change and adapt to outside stimuli). Specifically, the reward pathway eventually degrades the biochemical processes needed in order to learn and adapt, which would completely explain why addicts and alcoholics find it impossible to change their ways despite having already lost their family, house, and/or job (Capuzzi & Stauffer, 2012).

In closing, the addictive process can be much more physically and chemically based than many people previously estimated. The biochemical processes are just now being unearthed, and they provide revolutionary understanding about how addicts get started and get stuck. Further research promises to elucidate avenues to stop this reward pathway from becoming a runaway freight train. It certainly won’t be easy, for addictions encompass just about every factor imagined and probably can’t ever be reduced to just the reward pathway in and of itself. Nonetheless, I believe the reward pathway is one of the most important concepts in the broader addictions-recovery processes.

 

 

References

Capuzzi, D., & Stauffer, M. D. (2012). Foundations of addictions counseling, 2nd ed. Upper Saddle River, NJ: Pearson Education, Inc.

Derby. (n.d.). Addiction: The development of tolerance. Retrieved from http://www2.derby.ac.uk/ostrich/intro_to...age_05.htm

Marohn, S. (2011). The natural medicine guide to bipolar disorder. Charlottesville, VA: Hampton Roads.

Rocha do Amaral, J., & Martins de Oliveira, J. (n.d.) Limbic System: The center of emotions. Retrieved from http://www.healing-arts.org/n-r-limbic.htm
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#2
abnormal psych? for what major? if I may ask Smile

I love psych...especially abnormal. they were my fave classes
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#3
Professional Counseling, aka, Psychotherapy.

My ambition will be to also provide dream therapy once I get my license.
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#4
cool Smile

I was gonna do psychotherapy...I got distracted lol
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#5
just a question cause I am curious.

IF substance can actually affect the person’s ability to learn, both in the intoxicated state and the withdrawal state. In fact, the dynamics happening in this area could very well explain why addicts and alcoholics have such a loss of control

If we were to cure this addiction state, how many artist would lose their creativity? Or would they?

5 Famous & Iconic Drug Users That Inspired The World
http://www.finerminds.com/personal-growt...the-world/


Famous People Who Have Been Addicted to Opiates
http://www.michaelshouse.com/opiate-addi...d-opiates/
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#6
Wow. I don't know of a better way to introduce my eventual therapy for bipolar clients. As you might know, bipolar is very well correlated with creativity, and I can go on and on about this topic. Now, I just happened to have started a new model for living some time ago, and since I started my recent degree, I've become hell-bent that I will one day convert my model into a bipolar therapy model. Right now it's called "YippYball," but that would obviously change to make it much more scientific. Anyway, the future therapy would be modeled off of this.... www.yippyball.com

In essence, esholars is DEAD ON RIGHT! If we only concern ourselves with equalizing the neurotransmitters, we accidentally create zombies. Note that this is exactly what is happening with all the anti-psychotic medication being freely disseminated to so many Americans. So the answer isn't to keep the hormones exactly balanced at all times, but rather to get the ecosystem in balance. And this would allow creative bipolar people to learn how to get even more creative without having the psychotic episodes.....ideally all this would happen without mainstream medication. We'd do it holistically.
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#7
Also, please note that the most creative times are NOT when these people are extraordinarily high or suicidal. The biggest creative period happens to be at the onset of what we call mania. But the biggest point is that the mania to creativity isn't linear. That is, the more mania you have does not mean that you'll have more creativity. In my model, our goal will be to enhance the creativity while also removing the addictive crutch. Substance abuse, if left untreated, rarely ends well (Hendrix, Morrison, etc.)
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#8
bipolar I understand. Manic ups and depressed downs I know these things well, some family suffers this. They can be hell to live with. Most are very creative and produce massive amounts of work (not all of it any good) when up but the downs are very dangerous, overdoses of meds are potential, poor social choices often result in leagle woes, and divorce is common. Some of them do learn to cope eventually. It would have been nice to know about this when they were younger. Sugar does not help!
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#9
Once again, you're spot on, esholars. >95% of marriages with at least one bipolar diagnosis ends in divorce.
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#10
sadly, many docs and therapists rush to label rather than taking as much time as needed to really understand the patient first...
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#11
Still, you get a direct hit on that statement. Mental Health diagnosing (i.e., Labeling) is one of the biggest tragedies of our age.
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#12
Sadly I lost my manic part in the walmart parking lot one day after watching people there! I have been depressed ever since.
Sorry, but I did really lose my bipolar Manic symptom at a Sam's club during a sever head pain attack. After taking a pill the pain stopped and some days later some of the symptoms had disappeared.
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#13
NADW: WE are the beneficiary of your presence!

Esholars: I know that some migraine prescriptions overlap those typically assigned to bipolar, schizophrenia, and even parkinson's, so your experience makes some sense.
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#14
Esholar I love your sense of humor yet have great compassion for that pain. Sending you Reiki healing energy.
Windy- you rock woman. No reason for addiction girl- NDC it BE just IS wassup and happenin'.
Chris-
I spent several years working the nursing end of mental health~ I grabbed every word you wrote and savored it. That and a glass of wine made for a good evening read. Am I addicted yet? To the wine I mean, well it is a holiday eh.........kick back after work and enjoy the read versus a TV.
Now- here is a wee bit of input to that on a more esoteric level perhaps- but may be not. Quantum science again interjects its fuzzy little head a wee bit, along with spirituality...yet on a biological level. CELLS talk to each other. DNA goes beyond the physical
Dr. Bruce Lipton- The Wisdom of Your Cells - How Your Beliefs Control Your Biology, 2006
The Biology of Belief – Unleashing the Power of Consciousness, Matter & Miracles 2005
He has been a speaker at the Institute of Noetic Sciences' 13th international conference, the Spiritual Science Fellowship International Conference, and various other conventions.
These books discuss the power of the cell biology to become and mobilize what we actually think.
Yikes to those addicted (aren't we all to something?) and I wonder why more treatments don't stem from this point of view and of course the next listing here-
Brendan D. Murphy- Junk DNA: Doorway to Transformation- www.nexusmagazine.com Sept 2012
The Grande Illusion: A Synthesis of Science and Spirituality
Discussing the portals and pathways that our DNA open up into (like a CERN collider) and its implications.
If therapists were to examine the deeper core issues, utilizing the knowledge of cellular and DNA research we might not need Big Pharma.
I've worked with many a therapist who could've used therapy themselves. One gal was so hooked on valium I had to lift her head off her desk just to speak to her to get data on her patients...she was brilliant BTW, crazy but brilliant.
also this tragic reality-
http://www.npr.org/2015/05/22/408680019/...-his-story
"...He is one of the millions of Americans who became addicted to heroin after first getting hooked on prescription painkillers."
Sam Quinones' book, "Dreamland: The True Tale Of America's Opiate Epidemic,"
Talks about PILL MILLS out of Portsmouth Ohio where unethical doctors write the prescriptions that got thousands hooked on opioid that the body grew a tolerance for and when the supply dried up the patient/addict turned to street heroin.

How many patients did I see come and go that suffered from what Chris describes in his treatise above. First the propensity, then the grab.
Thanks Chris. that was a real pearl, a gem.

now for the borderline personality disorders that sit in CONgress...what is the treatment for that?
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#15
Windy, part of the ACA ethics is that I shall not treat any family member (i.e., I shall not provide therapy to anyone close to me). That makes that pretty easy, but in reality it would be awfully difficult to go completely hands off. That being said, please amplify the question and I'll be able to know where you're going with this (so I don't add spurious thoughts that weren't in line with your thought pattern here). Smile
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#16
Ah, gotcha!!

Well, I am actually not qualified to answer that question. I am planning to eventually get that type of training, but for now I would be forced to refer the addict to a very specificly trained professional. Honestly, probably the best bet would be a licensed naturopathic psychiatrist. They do exist, but it would be extremely hard to find, probably.
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#17
Yep! You found one....except that's the wrong coastline Smile

Keep in mind, that no matter who you choose, mainstream or holistic or naturopath, you should also compliment the treatment with certified psychotherapy. Certainly not all addictions are chemically or even biologically based. Some may be behavioral, meaning the person might have learned the behavior from other people, or cognitive, meaning that the addiction originated from an erroneous belief about themselves (just a couple of examples.) Here's another example: the addiction may have originated from a sense of worthlessness, and if that is the case, then seek an existential or transpersonal counselor.
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