WHY COMPLETE ABSTINENCE?
ERIC J. NESTLER and ROBERT C. MALENKA study the molecular basis of drug addiction. Nestler, professor in and chair of the department of psychiatry at the University of Texas Southwestern Medical Center at Dallas, was elected to the Institute of Medicine in 1998. Malenka, professor of psychiatry and behavioral sciences at the Stanford University School of Medicine, joined the faculty there after serving as director of the Center for the Neurobiology of Addiction at the University of California, San Francisco. With Steven E. Hyman, now at Harvard University, Nestler and Malenka wrote the textbook Molecular Basis of Neuropharmacology (McGraw-Hill, 2001).
How is it possible that diverse addictive substances--which have no common structural features and exert a variety of effects on the body--all elicit similar responses in the brain's reward circuitry?
How can cocaine, a stimulant that causes the heart to race, and heroin, a pain-relieving sedative, be so opposite in some ways and yet alike in targeting the reward system?
The answer is that all drugs of abuse, in addition to any other effects, cause the nucleus accumbens to receive a flood of dopamine and sometimes also dopamine-mimicking signals.
Drug abuse produces long-term changes in the reward circuitry of the brain. Knowledge of the cellular and molecular details of these adaptations could lead to new treatments for the compulsive behaviors that underlie addiction.
White lines on a mirror. A needle and spoon. For many users, the sight of a drug or its associated paraphernalia can elicit shudders of anticipatory pleasure. Then, with the fix, comes the real rush: the warmth, the clarity, the vision, the relief, the sensation of being at the center of the universe. For a brief period, everything feels right. But something happens after repeated exposure to drugs of abuse--whether heroin or cocaine, whiskey or speed.
The amount that once produced euphoria doesn't work as well, and users come to need a shot or a snort just to feel normal; without it, they become depressed and, often, physically ill. Then they begin to use the drug compulsively. At this point, they are addicted, losing control over their use and suffering powerful cravings even after the thrill is gone and their habit begins to harm their health, finances and personal relationships.
Neurobiologists have long known that the euphoria induced by drugs of abuse arises because all these chemicals ultimately boost the activity of the brain's reward system: a complex circuit of nerve cells, or neurons, that evolved to make us feel flush after eating or sex--things we need to do to survive and pass along our genes. At least initially, goosing this system makes us feel good and encourages us to repeat whatever activity brought us such pleasure.
But new research indicates that chronic drug use induces changes in the structure and function of the system's neurons that last for weeks, months or years after the last use.
These adaptations, perversely, dampen the pleasurable effects of a chronically abused substance yet also increase the cravings that trap the addict in a destructive spiral of escalating use and increased fallout at work and at home. Improved understanding of these neural alterations should help provide better interventions for addiction, so that people who have fallen prey to habit-forming drugs can reclaim their brains and their lives.
DRUGS OF ABUSE: The policy at KPC is abstinence from all forms of mood altering and mind altering substances. We work clinically with patients to implement harm reduction techniques until they gain their traction in recovery.
Alcohol - all forms including cold medicine, mouth wash, etc.
All Illegal drugs
Prescription drugs
Anti-Anxiety agents (Valium, Librium, Ativan, Xanax, Klonapin, etc)
Muscle Relaxers (Soma in particular)
Sleep Aids (Ambien, Lunesta, Sonata)
Pain Pills - All prescription painkillers are extremely addictive
Amphetamines (Ritalin, Adderall, Vyvance)
Seraquel
