A doctor's blog and more info about benzos

[Ne/Neva Eva]

I know I've posted this blog before, but it seems relevant again.

I've linked to one of his entries about benzodiazepines. There is a lot of other pertinent, thought-provoking and profound information on his site, too.

He wants to address the systemic problems in traditional treatment. He also prescribes HDB at his practice and in his rehab.

Substance Matters

[Ne/Neva Eva]

A doctor's blog and more info about benzos

This one is really good. I wish I'd read something like it when I first got here. Forgive the editorial bolds, please. Call it an attempt to highlight for those without a lot of time.

It's from the same blog, but is n article originally published in the Baltimore Sun. Substance Matters: April 2011

FRIDAY, APRIL 15, 2011

Concise description of the neurobiology of addiction
In this Baltimore Sun article Dr. David Linden of Johns Hopkins University gives an unusually succinct description of the underlying neurobiology of the development of addiction. Note the interplay between genetics and intoxicant exposure: if you're brain isn't genetically vulnerable, you are not likely to become addicted to a particular drug. Note also that this vulnerability is substance-specific, not a generalized "addictive personality."
MW

Baltimore Sun

Johns Hopkins neuroscientist David Linden explains the biology of pleasure
With his new book, he seeks to find out why vices -- and even virtues -- can hold such sway over our lives

By Mary Carole McCauley, The Baltimore Sun

April 14, 2011


Not all addictions live up to their advance press.

In the past decade, it's become common to casually and humorously describe a favorite activity in the parlance of chemical dependency. People speak of being "addicted" to chocolate or high-fat foods, playing video games, buying expensive designer shoes, watching weekly episodes of "American Idol" to sleeping on high-thread-count sheets. But according to "The Compass of Pleasure," a new book by Johns Hopkins neuroscientist David Linden that is being released today by The Viking Press, just two of those pursuits -- eating fatty foods and shopping -- can become genuine addictions for some people. Watching television, playing World of Warcraft and swaddling yourself in Egyptian cotton probably cannot.

Who knew that feeling good could be so complicated?

"Addiction is defined by the changes that certain activities can make in the brain," Linden says.

"Basically, some activities have been shown to short-circuit the medial forebrain pleasure circuit. The process is the same, whether someone is taking crack cocaine or gambling or having risky sex or shopping. These morphological changes bring about a gradual transition from liking to wanting, and the result is compulsive behavior."

The vast majority of people who pursue habit-forming activities will never become compulsive. Our genes play a major role in determining who will become addicted, how badly and to what substance. It also generally takes repeated exposure for a harmful habit to develop.

For example, Linden points out that for even a drug as highly addictive as heroin, two of every three people who inject the narcotic directly into their veins don't become junkies.

In addition, some pursuits that may technically qualify as addictive carry positive benefits for individuals and society that vastly outweigh the potential harm, such as running a marathon, or an extended bout of contemplative prayer.

"Pleasure is our compass, no matter what we do," Linden says.

"But a philosophical question arises from these findings. If we catch a pleasure buzz from our noblest instincts, does that make them less noble?"

Conversely, just because a substance doesn't create a physical dependency doesn't mean it's safe. LSD might not activate the medial forebrain, but someone who drops acid and jumps off the roof because he thinks he can fly is likely to get hurt.

"There's a whole bunch of risk-taking behaviors that aren't addictive," Linden says. "We're motivated by reasons other than seeking pleasure."

Addiction, he says, is just one form of learning. The changes that occur inside the brain when someone studies calculus are nearly identical to the changes that occurs when he smokes crack.

As Linden explains it, when human beings bliss out by watching a sunset, getting a back rub or drinking a glass of red wine, the ventral tegmental area in our brains is releasing a neurotransmitter called dopamine that is getting picked up by a nearby bundle of neurons called the nucleus accumbens.

Under normal circumstances, pleasure flows and ebbs; dopamine gets released and then reabsorbed for later use. But some activities hijack the pleasure circuit, either by increasing the amount of dopamine flooding into our systems or by blocking the portals through which the chemical messenger goes back into storage.

The result is a jolt of pleasure so intense that most people will do anything to feel it again.

"Addiction is a super-potent experience," Linden says. And, just like Pavlov's dog, "we learn to associate it with sensory cues," he says, "because these associations allow us to predict how to behave so we can repeat the experience."

When we make a connection between, say, our sweet tooth and a chocolate store located in the Inner Harbor, our brains get rewired. After repeated exposure, structures on our neurons called "dendrites" grow new spines. (The same thing happens when we learn our multiplication tables or memorize a new route to work -- both experiences that humans experience as pleasurable, though to a lesser degree and by a more indirect pathway.)

In the future, every time our car turns onto Pratt Street, we may feel a sudden urge from out of the blue to stop at the chocolatier we know is just down the block.

"If you look at the neurons under a microscope," Linden says, "you will see that the receiving ends of their dendrites have turned into a shaggily bush of spines.

"This is how people develop cravings. If you're an addict, the more times you take a drug, the more spines you'll have on your dendrites and the harder it will be to stay clean, because everything you do will trigger those associations."

There's also another problem. As any chocoholic will confirm, no mouthful will ever deliver a burst of flavor as sublime as the very first taste. In scientific jargon, we've become "habituated."

The gradual draining away of pleasure is the process that Linden is talking about when he describes "liking turning into wanting."

"We imagine that addicts experience more pleasure from their drug of choice than others, and that this motivates their compulsive drug-seeking," he says.

"But the research shows that addicts get less pleasure from their drug than other people. The chemical contact between the neurons gets less efficient over time. It gets worn out. As a result, addicts need higher and higher doses to get as much pleasure as they received the first time they took the drug."

Linden acknowledges that one of his motivations for writing this book was political.

"The Compass of Pleasure" argues that as our laws ignore the biological basis of addiction and instead treat the problem as simply a matter of insufficient willpower that can be resolved by punishment.

"Once we understand how the biology of pleasure works," Linden says, "the only reasonable conclusion that we can make is that addiction is a disease. What we're left with is a compassion model, not a model that says that addicts are losers and should be locked up in jail."

He concludes that if addictions of all types rewire the brain, the eventual solution may lie in devising medicines that can bring about permanent changes on a molecular and cellular level that can undo the damage caused by too many doughnuts, cigarettes or trips to the casino.

There's no question that addicts attempting to kick their habit face an uphill battle -- but Linden isn't letting them off the hook.

"The development of an addiction is not the addict's fault," he says.

"But believing that addiction is a disease does not absolve addicts from responsibility for their own recovery. It's not a free ride."

[windycitylady]

A doctor's blog and more info about benzos

I'm on break and only have a minute, but had to say THANKS, Ne! This is awesome stuff!

[Greg]

A doctor's blog and more info about benzos

Thanks Ne for posting this. It is very relevant to people here. Personally I think it was the dopamine hit from alcohol that started my own addiction. I have noticed a very similar thing with marijuana, even though it wasn't originally thought to affect dopamine all that much.

As for getting less and less pleasure, I have seen that in friends of mine who are alcoholics, and also in my own case. Originally I only needed a few beers to get the desired high, but that ended up becoming 6, 8, 10 ,12, etc. A few days ago I visited a mate, and he was depressed about the fact that he could not feel good from his alcohol. I asked him how much he had drank, and he threw an empty 4 litre wine cask on the ground and said he had drank all that the previous day and it did not get him drunk...that is 30 standard drinks!!

[Greg]

A doctor's blog and more info about benzos

...I also agree with that doctor's blog by the way, and I have never experienced any desire to abuse benzos to get high, as they simply don't work like that for me. I know some people do abuse them, but I have found only a minimal similarity between them and alcohol...cannabis is far more addicting with me than are benzos.

[SKendall]

A doctor's blog and more info about benzos

Thanks for posting this, it's very important.

[spacebebe01]

A doctor's blog and more info about benzos

Hi Ne, some interesting reading there for a Sunday Morning lying in bed with a coffee and cigarette

"He concludes that if addictions of all types rewire the brain, the eventual solution may lie in devising medicines that can bring about permanent changes on a molecular and cellular level that can undo the damage caused by too many doughnuts, cigarettes or trips to the casino"

I always thought that was the intent of Campral.

I have always know that my addictive personality has not had me getting addicted to everything. There was a time when I was taking a lot of cocaine, but I was taking it for the buzz of a night, there was no way I wanted to get up in the morning and carry on, in fact I cant think of a drug that had anything like the effect of alcohol on me in an addictive way. Mind you I cant think of a drug I liked as much as alcohol, and I did try a lot of them in my time. What I am saying tho is that because I became addicted to alcohol I dont think that makes me more likely to become addicted to everything. I can overeat at times but dont want to continue doing that for long, the only other problematic thing I think of is shopping which I dont think is an addiction but is definatley a compulsive behaviour that I dont even realise Im doing at the time. And I am addicted to smoking and really really hate it but keep on doing it.

[Ne/Neva Eva]

A doctor's blog and more info about benzos

Hi, from my Sunday morning, Space! I wish I had a cigarette, but we are not smoking inside anymore and I can't be arsed to get off of it and go outside!

I have similar experiences in that I've used other drugs, and abusable medications, but found all of them lacking. I hated cocaine because the first couple of times I used it I was happily drunk and it made me un-drunk. I still cannot figure out what the hell anyone would want with that! And don't get me started about pot. I know it works for a lot of us, but I end up in the fetal position--mentally if not physically.

Anyway, all of your points, and the doctor's really resonate with me. It used to make me really angry when my doctors would not prescribe a medication they thought I needed because I was addicted to alcohol. It was mostly drugs for ADD, which I was diagnosed with as a young adult. I pretty much hate them, even now, and still take one when I'm in school and really need to focus. Amphetamines are very, very unpleasant, imho. Though I get why people would abuse them. And in fact, they are much more tolerable, in some ways, when abused. I know this from the days when I take too much. WOOHOO! Sure is easy to get a lot done when you don't need to eat or sleep. But of course it feels like hell, makes me impossible to be around, and is the opposite of what I want out of life.

Anyway. There is an under-current in the addiction-treatment community of people who are represented by this one. They are not the ones being trained in schools, unfortunately. It is very odd that in addiction treatment specifically academia is WAY more conservative than any place else. Bizarre. But the heads of the NIH, NIMH and a couple of the other alphabet soups (here in the U.S.) are very on board with the scientific research related to this.

Hope it's a good day, everyone.

[Ne/Neva Eva]

A doctor's blog and more info about benzos

btw, the "addictive personality" is so much malarkey. Think about how absolutely varied we are here, personality-wise. Sheesh. It is astounding, actually. Introverts and extroverts. Multiple substances, or one. Hard-headed and soft.

While in some ways we have much in common, we are also very unlike one another. And yet we have some version of the same disease.

[FarfallaP]

A doctor's blog and more info about benzos

A new book called "Zoobiquity" by cardiologist Barbara Natterson-Horowitz also has a section on addiction research which correlates, imo, with the findings David Linden presents in "The Compass of Pleasure." Fascinating reading, for those of us interested in this topic.

[windycitylady]

A doctor's blog and more info about benzos

Ne, I got on Amazon last night and bought "The Compass of Pleasure". I'm excited! His other book, is it called "The Accidental Mind"?, looks interesting too.
Btw, it's my understanding that "the addictive personality" is not a personality type that you're born with and causes you to get addicted to substances. Rather, it's a set of traits that a person adopts after having been addicted to substances for a long time.

[Ne/Neva Eva]

A doctor's blog and more info about benzos

Let me know how it is, will you? I think I've finished my last "for pleasure" book for the summer. (I know it's only June. pfffft)

As for the personality traits we have when we become addicted...They are always negative. Plus, I can think of 6 random people I know pretty well from MWO and I can assure you (and they'd agree) we have much less in common than you would think. I can pick 2 dozen I don't know, but based on their posts, I am pretty sure we have very, very little in common.

if this is simply a matter of chemical imbalance/dysfunction/diseased brain, then people with all kinds of personality traits get it. Type A to Z. Chronic use, genetics, epigenetics and circumstances...In that order. Is my take away anyway.

I guess that "personality traits" always brings to mind "character flaws" and "spiritual maladies." You know what I mean? It smacks of condescension. Or is this yet another thing that pushes my buttons and I should stop being defensive??? :H
I know a lot of perfectly "normal" extremely successful (whatever!) people that have absolutely NO addiction going on...And they are not particularly happy, kind or well adjusted. Much less spiritually connected. oy. That last one is just funny/ironic.