Addiction

How Drugs, Including Alcohol, Affect the Brain

The brain contains over 100 billion neurons, all of which work together in a delicately balanced symphony.  Neurons are brain cells that process and transmit information by electrochemical signaling.  Messages regarding external stimuli, emotion, muscle command and other sensory cues are sent along to the next neuron across a synaptic gap.  Some neurons have direct contact with as many as 10,000 adjacent neurons.  Billions of them are involved in every thought or action we undertake, no matter how simple.  Regular use of mood altering drugs upsets the delicate balance our brain strives to maintain.     

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Three Layers of Brain

The human brain developed over millions of years, each of the three layers that comprise the organ having developed as humans evolved and required higher functioning for survival.  The three layers are described below.

• The first layer to develop was the brain stem or ‘reptile’ brain.  The brain stem is located at the base of the brain, caps the spinal chord and helps control basic attention, arousal, and consciousness.  It is more combative than co-operative. 
• The second layer of the brain to develop is the limbic system or ‘animal brain’.   This regulates the ‘flight or fight’ neurochemicals, basic decision making and sexual arousal.  It stores memories that trigger strong emotions but can cloud and distort perceptions of ordinary experiences.  This layer’s development allowed animals to ‘read’ each other.
• The final layer to develop is the Cerebral Cortex or ‘higher brain’.  This largest, wrinkled, outer layer of the brain is responsible for attention, perception, awareness, conscious thought, and language. It is associated with organizing, problem solving, attention, planning, decision making and a number of more complex cognitive functions including behavior and emotion. The functions that make up the personality are initiated here.  In short, the frontal lobe is the portion of the brain that makes us who we are. 

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The Cerebral Cortex

  The portion of the brain most severely affected by alcohol and other drugs are the frontal lobes in the Cerebral Cortex. When over stimulated by drugs, the dopamine system in the frontal lobe of the Cerebral Cortex begins to shut down, leaving the Limbic System/animal brain in charge.

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The Limbic System

The idea of trying something different, more ‘intense’, looks quite appealing to the animal brain.  Usually, this happens as the addict begins hanging around people who drink or use the way they do, i.e. more than their old friends.  These same people are the ones who will introduce them to new drugs, usually when the addict is drunk or high and their inhibitions are low.  Even if they decline the first time a drug is offered, chances are that the animal brain will decide to give it a whirl when asked in the future.  Remember, addiction attacks the brain above all other organs.  This means the organ that tells your loved one how to think, feel and act does not work correctly.  The brain of the person you care about has been hijacked.  The person you love is no longer there.   With the limbic system in charge, the addiction has free reign to steadily progress; free reign to destroy organs like the brain, liver, heart, and pancreas.  It has free reign to cause malnutrition and diseases like cancer, AIDS, and hepatitis, just to name a few.   Once activated, the disease can only get worse, destroying lives along the way, until the person afflicted by it is helped into recovery, or dies from it.  There are no alternatives.  Once the disease process is activated, deciding whether or not to use a drug is no longer an option for the addict acting on his own.  While drug use was once an activity to bring about pleasure, at some point, the progression of the disease and the discomfort of withdrawal has made drug use about avoiding pain.   Additionally, brain imaging studies have shown that addiction severely alters brain areas critical to decision-making, learning, memory, and behavior control. The portion of the brain most severely affected by alcohol and other drugs are the frontal lobes in the Cerebral Cortex. When over stimulated by drugs, the dopamine system in the frontal lobe of the Cerebral Cortex begins to shut down, leaving the Limbic System/animal brain in charge.

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The Disease of Alcoholism

How Alcohol Affects The Body

In a normal drinker, the liver uses a two step process to remove alcohol from the body.  The first step is to break down the alcohol into a very toxic chemical called acetaldehyde.  The liver quickly and efficiently then breaks acetaldehyde down into the harmless chemical acetate(basically vinegar), and flushes it out. In the alcoholic’s liver, the same level of alcohol produces a higher level of the harmful acetaldehyde.  Making matters worse, their liver is only half as efficient at breaking the acetaldehyde down into acetate, the chemical the body can then pass, leaving the harmful acetate in the body longer. Finally, due to the alcoholic’s increasing tolerance to alcohol, an ever increasing amount of the harmful chemical acetaldehyde must be stored. This substance is stored in the fat, including the fat the makes up the brain.

Dangers of Having Acetaldehyde In the Body

• It weakens the synthesis of proteins by the heart and other muscles
• In the brain, it competes with neurotransmitters (and wins) interfering with the proper function of the brain
• Withdrawal symptoms are heightened, (prompting the next drink) and can act like  opiates, contributing to addiction to alcohol
• Previously stored acetaldehyde weakens the cells’ ability to process that chemical into acetate, keeping the acetaldehyde in the system longer still

Over months, years and decades of drinking, alcohol effects the functioning of the brain, causing mood and personality changes. It overwhelms the liver and kidneys, destroys the lining of the stomach and weakens the heart muscle.  Making matters worse, the body begins denying itself nutrient rich foods, which the cells need to rebuild themselves, in favor of the quick sugar fix supplied by the alcohol molecule.  Adding to the problems caused by the alcohol is the addict’s every increasing tolerance.  In a cruel twist, tolerance not only grows, but as drugs destroy the central nervous and digestive systems, tolerance lessens. This means that in the end stages of the disease, the body of the person who is used to drinking tremendous amounts of vodka or smoking a great deal of another drug one day finds that their body simply cannot process the drug.  The amount that for years produced their desired high becomes a potentially lethal dose. Many in the chronic stage of addiction have died due to an overdose caused by an amount that their body was previously capable of handling. Additionally, when the drug leaves the addict’s system and the withdrawal process (the central nervous system struggling to regain balance) begins, this leads to the addict feeling worse and worse.  Thus agitated, the addict returns to use.  This agitation is why people mistakenly think that outside events, circumstances, or the feelings themselves cause the addict to use.  

Cross Addiction

Why Switching or Mixing Drugs Doesn’t Work

Once alcoholism/addiction is activated in a person, the same devastating life effects will be clear whichever mood altering drug they choose.  Once addicted to alcohol, one cannot switch to “just” marijuana and avoid the internal and external damage caused by the disease.  Likewise, a person switching from cocaine to whiskey, or whiskey to beer may enjoy a temporary respite from the negative effects of mood altering substances, but this period will be short lived.  Keeping it simple, a drug is a drug is a drug. Adding to the danger, mixing drugs exponentially increases their potency. Three pills and three drinks does not create the same reaction in the brain as would six pills or six drinks.  The exponential effect means that this combination of drugs is the equivalent of nine pills or even more.  Combining drugs has many times proven fatal, with autopsies all too often revealing different drugs in the body of the person who has overdosed.  

The Good News

The good news regarding all this physical devastation is that the human body possesses amazing recuperative powers.  In all but the most chronic, late stage cases, organs heal and personalities return. Miracles of healing happen with such frequency in recovery that they amaze even doctors familiar with this disease and recovery from it.   In all but a few instances, family members can get their loved ones back.    “What happens during treatment is amazing. There is no other area in medicine where such a dramatic change in a person’s physical condition takes place over such a short period of time” -Robert Johnson, MD

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A New Lens

The fact that alcoholism/addiction is a brain disease explains the unexplainable.  It explains why the person acts like somebody who just doesn’t care, somebody you don’t know.  Why they seemingly have no ability to plan and no apparent sense of responsibility suddenly becomes clear. Only when the actions of the alcoholic are viewed through this lens can they begin to make sense.  As beliefs around a person’s behavior change, actions towards that person will change as well.  It will be understood that they need help as they can’t help themselves. With our advanced medical model of addiction, Masters level counselors who all have personal experience with recovery and the latest technology, we help addicts with every problem and from every background see the miracle of recovery. 

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Teens And Addiction

Dr. Anna Childress of the University of Pennsylvania describes a “stop,” “go” mechanism in the brain. The “go” system is the primal older part of the brain that responds to pleasure and pain – the mesolimbic reward system. The “stop” system is located in the frontal lobes of the brain and helps manage our impulses toward immediate rewards. The frontal lobes of adolescents, however, continue to develop into their twenties so that their initial reaction to alcohol and drugs, when pleasurable, is often not interrupted by the voice of reason. If the predisposition to addiction is present, the disease (which in adults can take decades to manifest) may then develop instantly. The disease is the same as for adults, but its physical, behavioral, and spiritual consequences come on much more quickly and with frightening consequences

The Early, Adaptive Stage of Addiction

One of the first symptoms of addiction is, ironically and tragically, an ability to increase drug intake and still function “normally.” It is ironic because most diseases incur immediate and obvious penalties, not benefits, and result in reduced functioning rather than improvement in functioning. But in the early stages of addiction, the addict is not sick, in pain, or visibly abnormal. In fact, the early, adaptive stage of addiction appears to be marked by the opposite of disease, for the addict is “blessed” with a supernormal ability to tolerate drugs and enjoy its euphoric and stimulating effects. This improvement in functioning is tragic because the addict has little or no warning of the deterioration inevitably to follow. In the early stage, the disease is subtle and difficult to recognize. It is characterized by adaptations in the liver and central nervous system, increased tolerance to drugs, and improved performance when using. The early stage of addiction is characterized by Adaptation, Tolerance, and Improved Performance: Adaptation: A general biological rule holds that when any bodily system is under stress it either adapts or suffers damage. Adaptation is actually a tool of survival, helping the body endure stressful changes in internal or external environments. Adaptational responses occur rapidly, spontaneously, and in most cases, without the person’s conscious knowledge. Tolerance: Every user has a specific tolerance to drug. Below his tolerance level, the user can function more or less normally; at levels above his tolerance threshold, he will act intoxicated. Tolerance is therefore a condition that can only be measured accurately in a laboratory where the user’s blood level and behavior can be carefully monitored. Addicts typically experience a dramatic climb in tolerance in the first stage of addiction and can often use huge amounts of drug without showing obvious impairment of their ability to walk, talk, think, and react. Anyone who observes the early- and middle-stage addict’s using behavior is familiar with the fact that the typical addict can use as much as a liter of wine, a dozen beers, or even a bottle of whisky without acting high. Improved Performance: In this early, hidden stage of addiction, the only visible difference between the addict and the non-addict is improved performance in the addict when he uses and a deterioration in performance when he stops using. Addicts in the early, adaptive stage of their disease also show improvement of functioning as the blood drug level begins to rise. But unlike the non-addict, this improvement continues with additional using. Even when blood drug levels remain fairly high—levels that would overwhelm the non-addict, causing him to stumble, stutter, and sway or become immobilized—the early addict is often able to talk coherently, walk a straight line, or skillfully maneuver a car. Only when the addict stops using and his blood drug level (BDL) descends, does his performance deteriorate—and it does so very rapidly. Tragically, the addict can only temporarily control his using behavior. Over a period of years, the cells’ dependence on drug becomes more firmly entrenched until, at some point, the addict no longer has a choice. He needs drug to function, and he suffers terribly when he stops using. The benefits of adaptation are gradually overshadowed by the penalties of deterioration.

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The Middle Stage of Addiction

The middle stage of addiction is characterized by Physical Dependence, Craving, and Loss of Control: As physiological changes gradually occur, the penalties of using begin to outweigh the benefits. Pleasurable using for a “high,” a lift in feeling and performance from a relatively normal base, gives way to a more urgent “using for medicine” to “cure” the pain and misery caused by previous using. The basic cause of the increase in penalties is deterioration. Organs and systems that once welcomed the large doses of drugs and tolerated their toxic after effects are being damaged. Now when the addict stops using, his suffering is more severe and prolonged. Physical Dependence: As [the addict] uses more, and more often, to get the desired effect, the cells of his body are exposed to drugs for long periods of time. The cell membranes become increasingly resistant to drug’s effects, and the mitochondria within the cells increase in size and shift functions in order to accommodate the drug. With these changes, the adapted cells are able to live and thrive in an environment where drugs are continually present in large amounts. If the addict over-uses his tolerance, the brain cells will be overwhelmed, and he will get high. If he stops using, the addicted cells will suddenly be thrown into a state of acute distress. They have become unable to function normally without drug. The cells’ distress when drug is no longer present in the body, or when the BDL is falling, is evident in various symptoms known as “the withdrawal syndrome.” Withdrawal symptoms demonstrate that physical dependence exists; they are the visible signs of addiction. Craving: Craving is the overwhelming need for a use. Like everything else in addiction, craving is progressive. In the middle stages of the disease, craving becomes a need—the addict needs to use because his cells are physically dependent on drug. As tolerance increases and physical dependence sets in, the addict gradually loses psychological control over his physiological need for drug. Finally, will power, self-restraint, and the ability to say “no” have no power over addict craving. The physical need for drug overshadows everything else in the addict’s life. Loss of Control: As the addict progressively loses control over his using, he is no longer able to restrict it to socially and culturally accepted times and places. He often uses more than he intended, and the using continues despite extremely punishing consequences. He may use in the morning, at lunch, in the middle of the night; he may use in the car, the bathroom, the garage, or the closet as well as the tavern. His using behavior can no longer be disguised as normal or even heavy using. His inability to stop using—despite his firm resolution that he will stop after one or two—is striking confirmation that he is physically addicted to drug. The addict loses control over his using because his tolerance decreases and the withdrawal symptoms increase. The addict’s tolerance, which was so high in the early stages of the disease, begins to decrease because his cells have been damaged and can no longer tolerate large amounts of drug. While tolerance in lessening, the withdrawal symptoms are increasing in severity. The addict is now in the dangerous position of needing to use because he suffers terribly when he stops using but being unable to handle the high levels of drug needed to relieve the symptoms. He has also lost the ability to judge accurately how much drug his body can handle. As a result, he often over-medicates himself with drug, using to the point where he either loses consciousness or becomes so violently ill that he is forced to stop using.

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The Late, Deteriorative Stage of Addiction

The late, deteriorative stage of addiction is characterized by Malnutrition, Secondary Disease, and Death: The late-stage addict spends most of his time using, since otherwise his agony is excruciating. During the late stages of addiction, the addict’s mental and physical health are seriously deteriorated. Damage to vital organs saps the addict’s physical strength; resistance to disease and infection is lowered; mental stability is shaken and precarious. The late-stage addict is so ravaged by his disease that he cannot even understand that drug is destroying him. He is only aware that drug offers quick and miraculous relief from the constant agony, mental confusion, and emotional turmoil. Alcohol, his deadly poison, is also his necessary medicine. Malnutrition: All addicts suffer from malnutrition to some degree. A number of factors work together to make this condition almost synonymous with addiction. Large amounts of drug interfere with digestion and passage of nutrients from the intestines into the bloodstream. The addict’s liver has a decreased ability to convert and release nutrients and make them available throughout the body. Without adequate nutrients, the cells, already weakened by long exposure to drug’s toxic effects, are not able to create bone, tissue, blood, or energy. The sick and injured cells thus do not have the resources to repair themselves, and damage continues unchecked. Even the addict’s earliest psychological and social problems stem from or are aggravated by nutritional deficiencies. For example, a thiamine deficiency (extremely common in addicts) can cause loss of mental alertness, easy fatigue, loss of appetite, irritability, and emotional instability. If the deficiency is allowed to continue, more severe mental confusion and loss of memory may develop. In the later stages of addiction, the addict is often so sick that he cannot eat, thus aggravating the already serious nutritional deficiencies. Massive vitamin or mineral deficiencies caused by long and heavy using may result in several unusual diseases of the central nervous system, including polyneuropathy (tingling sensations), Wernicke’s encephalopathy (headaches, tingling, double vision), Korsakoff’s psychosis (hallucinations), and amblyopia (blurred vision).

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Secondary Diseases linked with late-stage addiction

• Heart: Heart Failure is characterized by symptoms of cardiomyopathy (disease of the heart muscle), cardiac arrhythmia (abnormal variations of heart beat), and hypertension (high blood pressure).
• Liver: Fatty Liver is characterized by enlarged, inflamed fatty deposits. Symptoms include nausea, jaundice, and loss of appetite.
• Hepatitis, or addict hepatitis, is characterized by a liver which becomes inflamed, swollen, and extremely tender.
• Cirrhosis is characterized by a liver which is virtually plugged with scar tissue, and which can no longer remove poisons and toxins from the body’s blood supply.
• Gastrointestinal Disorders: Gastritis is an inflammation of the stomach lining severe enough to cause bleeding, bloating, indigestion, nausea, and headache.
• Ulcers form in response to increased secretions of hydrochloric acid in late-stage addicts.
• Respiratory Tract Diseases: In general, addiction causes damage to the lungs by interfering with the body’s normal defense mechanisms and thereby making the addict susceptible to respiratory infection and injury. This interference with normal functioning can lead to:
• Tuberculosis
• Chronic Bronchitis
• Emphysema
• Lung Abscess
• Pneumonia

In addition, addicts have an increased risk of head and neck, esophageal, lung, and liver cancers. In each of these cancers, drug probably acts in a different way, sometimes directly affecting the cells, other times indirectly increasing the cells’ susceptibility to cancer. Late-stage addicts also exhibit a higher risk for pancreatitis, an inflamed gland condition characterized by severe pain in the upper abdomen, nausea, vomiting, and constipation.

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Final Stage- Death

If the addict continues to use, drug will kill him one way or another. Estimates vary, but according to one source, one-third of addict deaths are from suicides or accidents such as drowning, fires from passing out with a lighted cigarette, head injuries from falling, accidental poisoning, or car crashes. Those who survive these hazards are destroyed by direct and massive damage to body organs and systems.

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