Ethics Articles
Articles: Addiction
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Chains Around the Brain: The Neurobiology of Addiction (990512)
Ritual Self-Destruction (990512)
Pick Your Poison: Alcohol’s Toxic Downside (Foxnews, 990504)
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NEW YORK — As researchers learn more and more about the mechanisms of the human brain, their findings support the view that addiction is as much about behaviors as about substances.
In this new brain-based model of addiction, explained Dr. Richard Irons of the Menninger Clinic in Topeka, Kan., “addictive behavior is sustained not by fear of withdrawal but by the longing for the brain reward resulting from drug use.”
The brain area most involved in this “brain reward system” appears to be the nucleus accumbens — a tiny area at the top of the brain stem which seems to be the brain’s “pleasure center,” Irons said during a presentation at the American Society of Addiction Medicine Conference last month in New York.
The nucleus accumbens is believed to be responsible for the production (and storage) of dopamine, the brain chemical that creates feelings of pleasure. And alcohol, cocaine, methamphetamine, heroin and nicotine are all believed to increase dopamine levels in the body.
“It is thought that the dopamine system in the nucleus accumbens is involved in pathways of all drugs and abuse,” said Dr. Stephen Kish, Ph.D. the Director of the Human Neurochemical Pathology Laboratory at the Centre for Addiction and Mental Health in Toronto, Ontario.
“When one takes the drug methamphetamine, for example, this causes a release of dopamine from the nerve endings,” Kish explained. “And when a massive flood of dopamine interacts with dopamine receptors, this somehow results in pleasure, although the exact cascade of events is something we haven’t sorted out.”
Interestingly enough, dopamine may also be released in response to sexual stimulation as well as other, more subtle experiences such as infatuation or a good meal. This similar pathway of sex and drugs “may explain the similarity of a wide variety of addictive behaviors,” said Irons.
The dopamine-pleasure connection could go a long way toward explaining why people become physically dependent on drugs.
Kish, who has studied the brains of people who have died from methamphetamine overdoses, has found that the nucleus accumbens of these brains was almost always depleted of the dopamine stored in the tissues.
He believes this was because methamphetamine stimulates dopamine production so much that the brain literally runs out of dopamine supplies, a phenomenon which may account for the extreme depression or “crash” experienced by chronic methamphetamine users after the drug’s effect wears off. According to this theory, chronic users are literally medicating themselves in order to restore their dopamine levels.
What results is “a repetitive cycle that creates self-destructive and self-defeating behavior and consequences,” Irons said. “We call that addiction.”
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NEW YORK — The word “ritual” may conjure up images of hooded figures, foreign incantations and candelit corridors.
But a ritual can be anything from reading your morning paper along with your coffee to a self-destructive cycle of addiction — getting drunk at a certain bar, buying drugs or engaging in risky sexual activities.
These days, addiction specialists are focusing on rituals along with substances, because these rituals often serve as the “triggers” for an addiction (the same way that picking up your newspaper may stimulate your craving for morning coffee), according to Dr. John Sealy, who runs the sexual disorders unit at Del Amo Hospital in Torrance, Calif.
One of the most common rituals surrounding addiction — especially among male addicts — is some form of sexual scenario that is repeated over and over, where the person often tries to reenact a scene from movies, books, fantasy or their past experience.
This ritual, Sealy said, can be likened to a movie scene being acted out within the confines of a Hollywood sound stage. “Inside the sound stage, there is an entire play going on, that is being filmed with no interruptions from the outside environment.”
Unfortunately, Sealy added, “It always comes out the same way, so addicts find that the answer to a boring scene is to increase the drug.”
“Drugs are given to potential sexual partners as well,” Sealy added. “Not only does the person want to enhance their own sexual experience, but their actors in the play have to be compliant.”
Why do people use drugs with these scenarios in the first place? At least initially, drugs can create a mood, decrease inhibitions and fears, decrease performance anxiety and increase the intensity of a sexual experience.
Web Confessions
As one male participant in the newsgroup alt.drugs.hard wrote, cocaine and methamphetamine “can turn a common 20-minute [sex session] into an all-night lovemaking experience.”
“Of course,” he added “long-term use of either of these changes the sensations from positive to negative.”
Often with people who use drugs regularly as a part of sex, said Sealy, “there’s a mix-up between intensity and intimacy. They’re spelled very closely, but they’re quite different.”
This misguided need for intimacy may be what’s at the core of the addictive ritual.
One of Sealy’s patients, for example, would reenact the same solo ritual every weekend: He would go home alone, get drunk, use cocaine and Viagra and masturbate while watching pornographic videos and smoking cigarettes.
But then, the patient “would go up to the TV screen in an extreme state of intoxication and kiss the screen, in a desperate effort to have some kind of connection with the figures on the screen.”
This story only confirmed Sealy’s long-held belief: “that all addictions are about trying to connect with something.”
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NEW YORK — We’ve all read the studies saying a little wine is good for the heart. But recent research suggests wine and other alcohol can do serious harm to the body — even when consumed in relative moderation.
The price of drinking as little as two drinks per day includes the following, according to leading alcohol researchers’ presentations at the American Society of Addiction Medicine’s annual meeting last Friday in New York City:
An increased risk of gastrointestinal and other cancers, which is amplified in smokers Deficiencies in vitamin A, folate and other key nutrients in cell metabolism which cannot be easily corrected through supplements The development of a “fatty” liver or even cirrhosis
What about the coronary benefits of a glass of wine?
Wine Drinkers, Take This to Heart ...
The heart-healthiness of your favorite Merlot is not as clearly established as some would have you believe, alcohol experts argued.
The research on which these purported benefits are based comes from a Danish study which showed that people who drank one or two glasses of wine per day had decreased mortality compared to those who never drank. Dr. Charles Lieber of Mt. Sinai School of Medicine said the study also found that people who drank once a month also were protected against coronary disease.
“Should you conclude that one glass of wine a month protects against coronary complications? Obviously not,” Lieber said.
Instead, said Lieber, the result was due to the fact that the control group — people who never touch alcohol — was skewed. “Most people who never touch alcohol have good reasons not to touch alcohol. They often have a disease state that prevents them from touching alcohol.” And this group would naturally have a higher mortality rate for reasons that have nothing to do with their alcohol consumption.
Even if wine does help the heart, it mainly benefits people over 50 and people who already have heart disease and hardly justifies increased alcohol consumption, added Helmut Seitz, a professor of medicine at the University of Heidelberg in Germany who presented his research at the meeting.
“If you drink two glasses of wine, you should not increase that amount, [because] you could have a problem,” said Seitz. “It could be addiction, liver disease or cancer.”
“But if you don’t drink at all, don’t start. You may be at risk for other diseases. Instead, do all the other things that reduce your risk of heart disease. Stop smoking, [start] exercise, et cetera. It makes more sense.”
SAM-e to the Rescue
Fortunately, scientists are figuring out ways to reverse liver damage in drinkers.
In 1990, Lieber and his colleagues first experimented with a compound called S-Adenosyl-methionine (SAM-e) in baboons. This compound, an amino acid produced in the body, is important in building cell membranes. When excess alcohol is metabolized in the liver, an enzyme important in alcohol metabolism, (cytochrome P450 2E1), builds up and destroys cell membranes. Hence, researchers thought it would repair some of the cellular damage done by this enzyme.
Their results seem promising, so they proceeded to humans. In a randomized, double-blind trial conducted in Europe, the researchers gave cirrhotic patients either SAM-e or a placebo for two years. The mortality rate was 27 percent at the end of two years with a placebo; it decreased 10 percent with SAM-e. Lieber said these results will be published in next month’s issue of the Journal of Hepatology.
“This, I believe, is the first clear-cut demonstration of the results of a compound that reverses liver damage,” said Lieber.
SAM-e is now available in Europe for treatment and in the United States it can be purchased over the counter, although it is being advertised as an antidepressant. Lieber, however, said he doubted that the over-the-counter supplements were potent enough to really help with cirrhosis.
The Promise of PPC
Another compound being used experimentally to correct liver damage is a substance called phosphotidylcholine, or PPC.
Like SAM-e, PPC attacks the problem on the cellular level.
The toxic products of alcohol metabolism cause cell membranes — especially the membranes of the cell’s power plant, the mitochondria — to become damaged. PPC is involved in building the backbone of cell membranes, so Lieber and his colleagues thought it might repair some of this damage.
Lieber and his colleagues experimented with PPC extracted from soybeans, a form which the body easily absorbed.
“In our trials with baboons, PPC not only led to the correction of the deficiency of mitochondria ... most spectacularly, it led to a correction of the [fatty liver].”
Apparently, there are many reasons for this. PPC decreases the amount of acetaldehyde, a toxic product of alcohol metabolism, and also stimulates the activity of collagenase, the enzyme that breaks down the collagen.
This effect could lead PPC to be effective in treating not only alcoholic liver disease but any disease which leads to liver injury, such as Hepatitis C, Lieber said.
Currently, people around the country are enrolled in a trial to test PPC’s effect on liver disease. This is the fifth year of a six-year trial, so results — and possibly the treatment, Lieber said — should be available next year.
DID YOU KNOW?
Three percent of overall cancer and 4 percent of breast cancer may be due to alcohol and alcoholism
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