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The mind of an addict

Yes, it feels like slavery. Addiction literally changes the brain by destroying the way that it registers pleasure, and in the process, other drives like learning and motivation are corrupted. It chooses us. Oh, the doom! Once-upon-a-time, researchers believed that addiction was something that only afflicted folks who were morally flawed — sigh. Recovery from addiction does involve a certain amount of willpower, but as any legitimate addict will tell you, willpower alone will not cut it. Again, addicts are not derelicts. The brain of an addict is incredibly complex. Dopamine is a neurotransmitter—one that plays a major role in reward-motivated behavior. Addictive drugs pose one of the biggest threats to the brain, because they can release anywhere from two to ten times the amount of dopamine that natural rewards such as eating and sex do.
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Inside the Mind of an Addict

Addict behavior can sometimes be real-life versions of games we played as children. Back then, it was all in fun. Now, it can be deadly serious. Bluffing is a deceptive move in the game of poker that also appears in many other games of deception. It involves the pretense that everything is the way it should be, while in reality, you're being duped. Bluffing is the most popular of all the addict games. In many ways, addiction is the ultimate game of deception because becoming addicted means fooling yourself as well as those around you. As well as hiding information and hiding his or her addictive behavior, the addict will often hide the evidence of his or her addiction. People addicted to illegal drugs obviously have to be reasonably discreet in terms of where they store and keep their drugs and paraphernalia —needles, pipes, etc. Alcoholics may have hidden bottles around the house.
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5 Games Addicts Might Play

Brain power Psychiatry turns to neuroscience. Positive charge New technology to treat depression. Autism answers Parents run experiments to see what works. Sleuth of the mind A conversation with Oliver Sacks. Neuroscience of need Understanding the addicted mind. Hit record Conducting field research — literally — to explain concussions. Transition point The unmet medical needs of transgender people. It hurts! Taking the temperature of pain. Letter from the Dean Psychiatry and the brain.

Brain power Psychiatry turns to neuroscience. Positive charge New technology to treat depression. Autism answers Parents run experiments to see what works. Sleuth of the mind A conversation with Oliver Sacks. Neuroscience of need Understanding the addicted mind.

Hit record Conducting field research — literally — to explain concussions. Transition point The unmet medical needs of transgender people. It hurts! Taking the temperature of pain. Letter from the Dean Psychiatry and the brain. In this MRI of a brain side view , the green, yellow and red areas indicate bundles of neurons involved in addiction. Red represents reward pathways; green and yellow signify habitual responses. And like learning to ride a bike, addiction is not quickly unlearned. More than a third of the general public agrees, according to a survey by the federal Substance Abuse and Mental Health Services Administration.

Because addiction-associated brain changes are so enduring, a lot of people are going to relapse. So the course of treatment has got to be longer-term than it often is. Some of the key biological insights were made by Stanford neuroscientist Rob Malenka, MD, PhD, who continues his studies using animal models to extrapolate to humans. And now others, like brain imaging expert Sam McClure, PhD, are finding that changes Malenka sees in rats take place in humans as well. An equally important implication: They must also try their best — from both health and cost standpoints — to prevent people from starting down that lonely, dangerous road in the first place.

And much of that memory is false. And better, even, than they were the last time around. At least, it sure seems that way to the addict. About 25 million Americans are addicted to drugs including alcohol but excluding nicotine , about the same number as those who have diabetes. Malenka was among the first investigators to home in on the molecular details of just how the mechanisms involved in memory and learning are hijacked by drugs of abuse.

Addictive drugs mimic natural rewards such as food and sex by kindling a network of brain areas collectively called the reward circuitry, which is responsible for enjoyment — which if you think about it, is an important survival response.

It gets us to do more of the kinds of things that keep us alive and lead to our having more offspring: food-seeking and ingestion, hunting and hoarding, selecting a mate and actually mating. Over time, the desire for the drug becomes more important than the pleasure the addict gets from it. By the time the thrill is gone, long-lasting changes may have occurred within key regions of the brain. The brain is a little bit like the big snarl of tangled wires snaking their way out of that six-outlet surge protector behind your bed.

Nerve cells or neurons, as scientists call them can be seen as hollow wires transmitting electrical currents down long cables called axons to other neurons. He and other researchers are working to understand addiction as a sum of behavioral consequences of changes within nerve cells that occur with repeated drug use.

In the s James Olds, PhD, a postdoctoral researcher working with psychologist Peter Milner, PhD, at McGill University in Montreal, was conducting experiments to try to assemble a wiring diagram for some of this complicated brain circuitry. At one point Olds and Milner were shooting for an area of the brain called the reticular formation, an archipelago of interconnected clusters dispersed throughout the brain and involved in arousal and attention.

But they missed and hit another circuit by accident. They discovered that when they stimulated this circuit, the animals loved it. So the investigators tried something new. They taught the rats to press a lever in order to deliver shocks to their own brains, and recorded the points in the brain that rats liked to electrically stimulate over and over again by pressing that lever — and press it they would, sometimes for hours on end, to the exclusion of just about anything including eating or drinking.

So Olds and Milner did that for them. Point by point, Olds and Milner were able to map the network of brain regions, interconnected as they are by bundles of axons running from one region to the next, that became known as the reward circuit.

A brain, viewed from behind in two planes, showing the pathways implicated in addiction. The pathway travels from dopamine neurons central to areas in the striatum. But what flips on the reward circuit in regular life, when electrical zaps to the brain are blessedly few and far between? Dopamine is one of a growing number of known neurotransmitters, substances neurons produce for the purpose of relaying information from one neuron to the next.

Different groups of neurons manufacture different neurotransmitters, which all work pretty much the same way but in different nerve bundles and with a spectrum of different results. They diffuse across that space called a synapse to specialized receptors on the abutting neuron, where the interaction can either set off enhance or shut down impede a new electrical current in the downstream neuron.

These dopamine-squirting neurons constitute a tiny fraction of all neurons. But each of them can network with up to 10, or more other neurons stretching to the far corners of the brain. A dollop of dopamine in your tank can really boost your reward mileage, so to speak. It turned out that they do. Teach a rat to press a lever for an infusion of a drug of abuse, and you will see the same compulsive behavior in the rat that you would in a person. In this rear view of the brain, the colored areas show the origin of the dopamine neurons in the midbrain.

As these animal studies have shown, virtually all abused drugs — for instance, heroin and other opiates; cocaine, amphetamines and other psychostimulants; nicotine; and alcohol — operate by interfering with the reward circuitry. They cause the release of dopamine in target structures such as the nucleus accumbens, that key structure in the experience of pleasure. Different drugs do this in different ways. Cocaine and amphetamines prolong the effect of dopamine on its target neurons.

Heroin inhibits other neurons that inhibit these dopamine neurons. In the logic circuitry that is the brain, a double negative roughly equals a positive. You might think that the more you eat, or the more sex you have, or the more good vibrations you get, the more dopamine your reward-circuit neurons will squirt at their target structures in the brain. A seminal Science paper by P. The newer theory was based on animal studies involving lever pressing, with a twist. In this case, the test animal learns that if it presses a lever after it receives an environmental cue — to wit, a light goes on — it will get a reward: say, a nice slice of apple or a drop of juice, both of which rats love.

Of course, the animal soon learns to reach for the lever the instant the light goes on. With repeated exposure, the rat gets the hang of it, and a few interesting things happen inside its brain.

First of all, the reward itself the food no longer produces the dopamine surge associated with reward-circuit activation. Second of all, it is now the light, not the food, that triggers the activity in the reward circuit.

How much dopamine gets secreted depends not on how great the reward is, but on the degree to which it meets expectations. The reward circuitry is always secreting dribs and drabs of dopamine. Thus, the brain seems to interpret the absence of the expected reward not merely as a lack of enjoyment but as a punishment.

Sam McClure, an assistant professor of psychology at Stanford who studied under Montague, has been imaging human brains to visualize connections between the regions that constitute the reward circuit. Cocaine, heroin and other abused substances usurp this system. And they do it in a really creepy, pernicious way: by short-circuiting it. With normally rewarding things like food and sex, we usually have a pretty good idea of how good it will be.

But cocaine, heroin, alcohol and nicotine directly activate the circuit — they goose dopamine secretion — regardless of how high the expectation was. Every single time. In susceptible individuals, repeated drug use creates the same kind of lasting changes in the connections among neurons that we get from learning to ride a bike. One important way our brains snap an experience into long-term memory is by strengthening the synaptic contacts between neurons in the network that encodes this experience.

Drug abuse can also cause neurons to sprout brand-new synapses — for example in the nucleus accumbens, the hotspot for positive emotions. It can weaken synapses, too. Nora Volkow, MD, of the National Institute on Drug Abuse has shown that the plan-oriented prefrontal cortex functions poorly in cocaine addicts. If you are an addict, not just the drug but also all the associated physical, geographical and social cues exert a powerful effect, even decades after the last time you were anywhere near the drug: You walk past the bar you used to get drunk in and see your buddies in there, or you smell cigarette smoke — or, if you used to inject cocaine or heroin, all it may take is seeing a spoon — and you experience a craving and risk a relapse.

Only a fraction of people who experiment with drug use get addicted. But virtually all of us have an intact, functional reward system. The short answer is that nobody knows enough to be able to single out a potential addict with any certainty. One big risk factor, says Humphreys, is the age at which you start using. But the younger you start, the more likely you are to keep smoking. You want to make addictive substances as inaccessible as possible in the environment, particularly for young people.

Brain power Psychiatry turns to neuroscience Positive charge New technology to treat depression Autism answers Parents run experiments to see what works Sleuth of the mind A conversation with Oliver Sacks Neuroscience of need Understanding the addicted mind. Hit record Conducting field research — literally — to explain concussions Transition point The unmet medical needs of transgender people. Good grief Caregivers share sorrow It hurts! Special Report Neuroscience of need. Serendipity strikes In the s James Olds, PhD, a postdoctoral researcher working with psychologist Peter Milner, PhD, at McGill University in Montreal, was conducting experiments to try to assemble a wiring diagram for some of this complicated brain circuitry.

Dope fires up your dopamine Dopamine is one of a growing number of known neurotransmitters, substances neurons produce for the purpose of relaying information from one neuron to the next. Hijacking the reward system You might think that the more you eat, or the more sex you have, or the more good vibrations you get, the more dopamine your reward-circuit neurons will squirt at their target structures in the brain.

The needle and the damage done In susceptible individuals, repeated drug use creates the same kind of lasting changes in the connections among neurons that we get from learning to ride a bike. Who knows?



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