The Neurobiology of Addiction Addiction 101 in Olson
Summary
TLDRThis lecture delves into the neurobiology of addiction, emphasizing its status as a brain disease rather than a behavioral one. It outlines the disease model of addiction, affecting key brain areas like the frontal cortex and midbrain, leading to compulsive drug-seeking despite negative outcomes. The discussion highlights how drugs hijack the brain's reward system, causing a dysregulation in dopamine levels and resulting in a perpetual cycle of craving and use. The speaker advocates for a comprehensive treatment approach, including therapy, medication, and spiritual growth, to strengthen the frontal cortex and reestablish control over the midbrain's survival instincts.
Takeaways
- đ§ Addiction is a brain disease, not a psychological one. It involves actual changes in the brain, particularly in the frontal cortex and midbrain.
- đ« The disease model of addiction fits the medical definition of a disease, with an organ (brain), a defect (neurological changes), and symptoms (loss of control, cravings).
- đ¶ The midbrain, responsible for survival, is hijacked by drugs. It starts to believe it needs high levels of dopamine to survive, leading to addiction.
- đ Drugs of abuse, regardless of type, work in the midbrain and trigger the release of dopamine, which is the same neurotransmitter involved in natural rewards.
- đ The brain's pleasure system gets dysregulated in addiction, causing a decrease in dopamine receptors and a higher threshold for experiencing pleasure.
- đ Stress and trauma can lead to similar neurobiological changes as addiction, increasing the risk for addiction and relapse.
- đ Cravings are not just psychological; they are the result of an active midbrain sending physiological signals that the body interprets as needing the drug to survive.
- đ§ââïž Treatment for addiction involves strengthening the frontal cortex through therapy, 12-step programs, and spirituality to overpower the midbrain's drive for drugs.
- đ Medication-assisted treatment helps to quiet the midbrain's cravings, allowing individuals to engage in therapy and recovery programs more effectively.
- đ„ Addiction treatment requires a team approach, combining therapy, support groups, and medication when appropriate, to address the complex nature of the disease.
Q & A
What is the main reason for discussing the neurobiology of addiction?
-The main reason for discussing the neurobiology of addiction is to address the misconception that addiction is not treated as a disease despite being referred to as one. The lecture aims to reduce stigma and promote appropriate treatment by explaining the biological basis of addiction.
How does the disease model of addiction apply to the brain?
-The disease model of addiction applies to the brain by identifying the organ affected as the brain itself, with a defect in its neurological functioning leading to addiction. This model is typically used in medicine to define diseases, where there's an organ, a defect in that organ, and symptoms resulting from that defect.
What are the two major parts of the brain involved in addiction according to the script?
-The two major parts of the brain involved in addiction are the frontal cortex and the midbrain. The frontal cortex is associated with personality, values, ethics, morals, willpower, and conscious decision-making, while the midbrain is linked to survival instincts and is not under conscious control.
Why does the midbrain play a critical role in addiction?
-The midbrain plays a critical role in addiction because it is responsible for the brain's reward system and survival instincts. Drugs of abuse work in the midbrain, releasing dopamine and creating a false sense of needing the substance to survive, which leads to addiction.
How does the brain's response to drugs of abuse differ from natural rewards like food?
-The brain's response to drugs of abuse differs from natural rewards like food in the amount of dopamine released. While food releases dopamine to ensure survival, drugs of abuse release massive amounts of dopamine,èżè¶ the brain's normal threshold for pleasure, leading to a dysregulation of the reward system and addiction.
What happens in the brain when someone is addicted that causes them to continue using despite negative consequences?
-When someone is addicted, the midbrain erroneously believes it needs a high level of dopamine to survive, leading to cravings and loss of control. This results in persisting use despite negative consequences as the brain's reward system is dysregulated.
How does the script explain the role of dopamine in addiction?
-The script explains that dopamine is the neurotransmitter responsible for the brain's reward system and pleasure. Drugs of abuse cause a massive release of dopamine,èżè¶ the brain's normal threshold, leading to a downregulation of dopamine receptors and an increased threshold for pleasure, which is a key factor in addiction.
What is the significance of glutamate in the context of addiction as described in the script?
-Glutamate is significant in addiction because it is responsible for memory formation. It acts like an executive assistant to dopamine, helping to create and store memories associated with dopamine release, which can lead to cravings and relapse when exposed to similar environments or cues.
How does stress relate to addiction according to the script?
-Stress is related to addiction as it can lead to a downregulation of dopamine receptors, similar to the process in addiction. Chronic severe stress can increase the threshold for pleasure, making individuals more susceptible to the effects of drugs and potentially leading to addiction.
What are the three main factors that cause relapse in addiction as mentioned in the script?
-The three main factors that cause relapse in addiction are dopamine exposure, stress, and exposure to drug cues. These factors can trigger the midbrain to seek out dopamine, leading to cravings and potentially relapse.
How does the script suggest treating addiction effectively?
-The script suggests treating addiction effectively by using a combination approach that includes therapy, 12-step programs, group therapy, and medication if appropriate. The goal is to strengthen the frontal cortex to overpower the midbrain's cravings and to restore the brain's normal pleasure set point.
Outlines
đ§ Understanding Addiction as a Brain Disease
The speaker introduces the topic of addiction, emphasizing the need to treat it as a disease. They discuss the discrepancy between how addiction is viewed as a disease and how it is actually treated. The speaker is a board-certified expert in family and addiction medicine, with extensive experience in treating addiction. They explain the disease model of addiction, which is a framework used in medicine to define diseases based on organ defects and resulting symptoms. Using diabetes as an example, the speaker illustrates how addiction fits into this model as a brain disease, affecting the frontal cortex and midbrain. The frontal cortex is associated with personality, values, ethics, morals, and willpower, while the midbrain is linked to survival instincts. The speaker clarifies that addiction is a neurological issue, not a psychological one, and that the brain undergoes actual changes that result in addictive behavior.
đ The Neurological Basis of Addiction
The speaker delves into the neurological aspects of addiction, explaining how drugs of abuse affect the midbrain, which is responsible for survival instincts. They use the example of mice that will self-administer cocaine directly into their brains until death, demonstrating that addiction is not influenced by socioeconomic or cultural factors but is purely neurological. The midbrain's role is to ensure survival, and with repeated drug use, it starts to rely on high levels of dopamine to function, leading to addiction. The speaker explains that all drugs of abuse, regardless of their type, affect the same part of the brain and the same neurotransmitter system, hence there is no such thing as a specific drug addiction, but rather addiction in general. They also discuss how the brain's reward system is hijacked by drugs, leading to a constant search for the high levels of dopamine that drugs provide.
đ§Ș Dopamine, Pleasure, and the Brain's Set Point
This section explores the role of dopamine as the brain's pleasure chemical and how it is central to the brain's reward system. The speaker explains that the brain has a set point for pleasure, similar to how the body has a set point for temperature regulation. Drugs and alcohol can release excessive amounts of dopamine, causing the brain to down-regulate dopamine receptors, which in turn raises the threshold for pleasure. This leads to a decreased ability to experience joy from natural rewards, as the brain requires more dopamine to feel the same level of pleasure. The speaker also discusses the impact of chronic stress on dopamine receptors, which can lead to a similar down-regulation and increased pleasure threshold, setting the stage for addiction. They highlight the role of glutamate in memory formation and how it reinforces dopamine's effects, creating associations that can trigger cravings and relapse.
đ The Role of Cravings and the Midbrain in Addiction
The speaker discusses the concept of cravings as a manifestation of the midbrain's activation, which sends physiological signals to the body to seek relief. These signals can include sweating, chills, nausea, and restless legs, among others. The midbrain, in its quest for survival, will tap into the cortex to find reasons to use drugs, even if they are not warranted. This can lead to rationalizations and justifications for drug use, as the brain seeks to alleviate the discomfort caused by cravings. The speaker emphasizes that the outward behaviors associated with addiction, such as lying and manipulation, are symptoms of the underlying neurological changes and not simply a reflection of the person's character. They stress the importance of understanding these processes to effectively treat addiction.
đ Treatment Approaches and the Path to Recovery
The final paragraph outlines various treatment approaches for addiction, focusing on the need for a combination of therapies, 12-step programs, and medication when appropriate. The speaker emphasizes the importance of strengthening the frontal cortex to regain control over the midbrain's cravings and survival instincts. They discuss the role of abstinence in quieting the midbrain and the use of medications to manage cravings and reduce harm. The speaker also highlights the need for coping skills and stress relief, as well as spiritual growth, to empower individuals in their recovery journey. They conclude by stating that no single person can treat addiction alone and that a team approach, including therapy, support groups, and medical intervention, is necessary for success.
Mindmap
Keywords
đĄNeurobiology of Addiction
đĄDisease Model
đĄFrontal Cortex
đĄMidbrain
đĄDopamine
đĄRelapse
đĄCoping Skills
đĄSpirituality
đĄMedication-Assisted Treatment
đĄHarm Reduction
đĄPrevention
Highlights
Addiction is discussed as a disease that is not treated as such, highlighting the need to address the stigma and treat people with addiction appropriately.
The speaker is board certified in family medicine and addiction medicine, with extensive experience in various treatment facilities.
The disease model of addiction is explained, requiring a defect in an organ leading to symptoms, with addiction being a brain disease.
The frontal cortex and midbrain are identified as the key brain areas involved in addiction, with the former being responsible for personality and the latter for survival instincts.
Drugs of abuse are shown to work in the midbrain, not the frontal cortex, contrary to previous beliefs.
The midbrain's role in addiction is to seek out high levels of dopamine, leading to a hijacking of the brain's reward system.
Addiction is described as a stress-induced hedonic dysregulation, causing a decrease in dopamine receptor activity and an increase in the pleasure threshold.
The importance of glutamate in memory formation and its role in reminding the brain of situations surrounding dopamine release is discussed.
Relapse triggers are identified as dopamine exposure, stress, and exposure to drug cues, which can cause a small release of dopamine and trigger cravings.
The midbrain's activation during cravings is described as sending physiological signals to the body to motivate drug-seeking behavior.
The need to strengthen the frontal cortex through therapy, 12-step programs, and medication is emphasized to help overpower the midbrain's drive for drugs.
Medication-assisted treatment is presented as a way to quiet the midbrain and reduce cravings, allowing for better engagement in therapy.
The ultimate goal of addiction treatment is described as a combination approach, including therapy, 12-step groups, and medication when appropriate.
Prevention is highlighted as a key strategy in addressing addiction, with a focus on adolescents to prevent the development of addiction.
The definition of addiction is summarized as a dysregulation in the pleasure system, leading to loss of control and persistent use despite negative consequences.
Transcripts
so I'm going to talk about the
neurobiology of addiction or addiction
101 and the reason that I do this
lecture specifically is because we talk
about addiction as a disease but we
don't treat it as a disease and we
talked about how addiction affects
everyone and you know and we're saying
it's a disease process but nobody really
treats it like a disease process and
they say things to me like oh it's not
as bad as cancer right well known
disease as a disease and I think that
people need to understand that if we're
gonna get rid of the stigma and start
treating people with addiction
appropriately so essentially I am the
board certified in family medicine as
well as addiction medicine and I work in
a whole bunch of different treatment
facilities dealing with addiction all
day every day these are just some
objectives and disclosures you can read
at your own risk so it's the disease
model of addiction the disease model is
what we use in medicine so the disease
model essentially says that there is an
organ there's a defect defect in that
organ and there are symptoms because of
that defect so in order for something to
qualify as a disease it has to fit this
model diabetes the organ is the pancreas
the defect is a decrease in beta islet
cells the symptoms are high blood sugar
coma retinopathy etc so but all diseases
if we're calling them diseases fit this
model they have to fit this model and
there is no continuum it's just it's a
disease or not a disease so the question
becomes how do we get addiction to fit
this model so addiction is a brain
disease
we're starting at a disadvantage it is
not a purely psychological disease or
illness which is what everyone believed
previously it is a neurological disease
there's actual change in the brain that
occurs that results in addiction so
we're starting at a disadvantage because
the brain diseases often manifest this
behavior so you see someone with a brain
tumor or a lesion in the
brain they have personality changes they
behave differently they can become
impulsive or angry or difficult but we
excuse it because we know they have some
kind of tumor here they got hit in the
head or something but with addiction we
have a tendency to point at the addict
and say you're bad and this was your bad
choice but the disease is occurring in
the brain so in addiction we deal with
two major parts of the brain the frontal
cortex and the midbrain so the frontal
cortex is the part of our brain that
makes us us it makes you you it's where
your superpowers are it's your
personality your values your your ethics
your morals your willpower your sense of
choice it's all conscious that's where
you think and I use Superman to
represent it because it's your
superpower
a fully functioning frontal cortex like
everyone in this room right now is like
a fully functioning Superman an addict
or someone who is front frontal cortex
is not working properly is like weak
Superman I just need to simplify it with
pictures so the midbrain is the other
part of the brain we deal with and the
midbrain is your survival brain and it's
kept us alive for thousands and
thousands of years so it's doing a good
job but it is not conscious you have no
control over it you can't fix it or
change it or tell them what to do its
role in life is to keep you alive
that's it it doesn't wait consequences
it doesn't be like oh maybe this thing
no it says we're in danger we're gonna
die I have to take action to save the
life so I use the tiger it's more
primitive part of the brain so an angry
tiger no one in this room has right now
angry tiger is you're in the bear in the
woods and the Bears chasing you and
you're scared you're gonna die okay
angry tiger is an active midbrain so the
midbrain has three functions eat and
drink water to get nutrients fight or
flee from predator and procreate that's
it those are the only things it does so
when a baby is born one of the first
things we do is we feed it and the
reason that we feed it is because giving
the baby the nutrients releases dopamine
in the midbrain that active
the reward system and the baby
essentially becomes addicted to food we
have to get the baby addicted to food
because if the brain doesn't think it
needs it to survive the baby won't crave
food and it will die drugs of abuse work
in the midbrain and drugs and alcohol
for all intents and purposes are exactly
the same thing and I will explain why
okay but drugs the people abuse work in
the midbrain for years we thought they
worked in the frontal cortex because we
thought addictions of behavioral disease
but what we found is that if you put
probes into mice brains into the cortex
and into the midbrain and you give them
the option to hit a lever to administer
cocaine directly into their brain only
the mice that have the probes in the
midbrain will actually do it and they
will do it to the point of death they
will do it they will not eat they will
not sleep they won't do anything else
they will just administer cocaine until
they die so mice get addicted to drugs
but mice don't have you know like bad
families and they don't live in bad
neighborhoods and they didn't grow up in
the foster system and they don't have no
money
so this is not about you know anything
socioeconomically this is not about race
or culture this is simply about
neurology so what happens with repeated
use of a substance that's activating the
midbrain the midbrain starts to believe
erroneously that it now needs a high
level dopamine producing substance just
to survive so it gets hijacked basically
by drugs and so once it believes it
needs high level dopamine just to
survive it will seek out the high level
dopamine in any form which is why it
doesn't matter alcohol marijuana cocaine
and heroin there's no such thing as
heroin addiction or alcohol addiction
there's just addiction because if heroin
is what caused the change in the brain
alcohol will cause you to go back to
heroin that's it there's no it doesn't
matter that in the past you never had a
problem with alcohol it will lead to
relapse because it works in the same
exact place with the same exact chemical
so the example I always use for people
who are not addicts is if you're dying
of thirst in the desert and you're on
day 5 and your organs are shutting down
and you are about to die and I hand you
a bottle of water and I tell you I'm
gonna take your kids and your job and
your house and your family if you drink
the water you would take the water
everyone in this room would I don't care
how much you love your kids and your job
your house you would take the water
because the part of your brain that
values your children and your family and
your career is your cortex during times
of survival that's shut down your
midbrain is what has to keep you alive
and that doesn't care about your kids in
your job in your house and whatever so
you'll take the water drink it satiate
your midbrain and then your cortex comes
back online and goes oh my god I can't
believe it just gave up everything for
water and you try and manipulate me into
giving back your stuff so we can see on
a brain scan the difference between an
addict and someone who's just using
drugs there are people that just abuse
drugs they're not necessarily addicted
in order to be addicted bad things have
to happen because of your use and you
have to be unable to stop if you can put
it down and walk away
you were never addicted you've just used
drugs and maybe are a great choice maker
so if you put both people in a brain
scanner what you will see is for a true
addict you show them you put them in a
PET scan show them their drug of choice
brain scan will show midbrain lit up
frontal cortex dark take someone else
who just uses drugs put them in the
brain scan or show them the drug that
they like the most cortex lights up
their thinking about it I love it I hate
it whatever but their midbrain is dark
so you can see this you can actually see
this in brain scans and here's just some
examples of it so a non-user has a very
much more active cortex than an addict
and you can also see that it doesn't
matter even a hundred days abstinent
from a drug there's still less activity
in the cortex so the damage is is
long-standing and it takes a while to
get better
dopamine receptor activity is decreased
in the addicts so in the Attic the
midbrain dopamine receptors are down
regulated I'll explain why so addiction
is this broken pleasure sense it's our
reward system out of whack so here's how
our brains work in simple terms we
receive a signal from the environment
either chemical or electrical it comes
into neuron a he tells neuron a to
release neurotransmitter neuron a
releases the neurotransmitter into the
synapse and then that neurotransmitter
binds to neuron C which exerts an effect
I see a hole in the floor
I the electrical signal from the light
comes into my eyeball goes to my retina
it sends the signal it releases
acetylcholine or some other
neurotransmitter and then that tells
neuron C to move my leg so I step over
the hole whatever that's really simple
but that's essentially how our brains
work so with drugs the drug comes in it
binds to neuron a it releases dopamine
into the synapse dopamine binds to
neuron C and it says oh I'm really happy
or I'm really for a car I'm joyful or
whatever the effect of the drug is but
essentially it's not the drug that
matters it's the dopamine the dopamine
that was released into the synapse is
all that matters and it's the same
dopamine whether it was from alcohol
marijuana heroin crack methamphetamine
doesn't matter so it's not the drug that
matters its dopamine so the brain has
ten perceptual systems number ten is the
pleasure system that goes back to that
baby we have to become addicted to
certain things to survive so the reward
system is part of the pleasure system
also if you had no pleasure in life you
would have no desire to continue living
so things have to give you joy and
pleasure on a regular basis or we'd be
depressed and suicidal dopamine is the
pleasure chemical dopamine is what says
life is awesome this is great we're
having a great time I love this dopamine
is the neurotransmitter
mitr that we are addicted to or that
addicts are addicted to our brain has a
set point for pleasure just like we have
a set point for temperature for our body
regulation my body is the 98.5 degrees
because that's how I'm best most
optimally functioning I get exposed to a
bacteria or a virus my setpoint moves up
to 101 degrees because it knows it's
gonna kill off the bacteria at that
level once the bacteria is dead drops
back down to where it's happy 98.5
that's a fever that's how our bodies
work we have a set point in the brain
for pleasure the setpoint says that
things that release a certain amount of
dopamine are going to be viewed as
pleasurable so I can release dopamine
doing other things but if it doesn't
cross that threshold
I will not enjoy it so we have our
normal things like winning the lottery
or like getting married or something
exciting we release dopamine and we
think that's great drugs and alcohol
release massive amounts of dopamine just
massive amounts more than the brain
needs or really can tolerate so what
happens is the brain says we have all
this dopamine we don't need all these
receptors for dopamine so it starts
pulling off receptors they down
regulates receptors and what happens
when you down regulate receptors is you
move the threshold up so as the
threshold moves up you need more
dopamine just to feel the same amount of
joy you used to which means that you
know going on family vacation winning
the lottery playing the guitar things
that used to give you pleasure they're
still releasing the same amount of
dopamine but it's not enough to cross
the threshold so you don't actually
experience pleasure anymore
and this is why addicts will tell you
all the time they used to love to play
the guitar they used to love to knit so
do stuff and they don't anymore
they really biologically don't anymore
they can't you joy from it stress works
just like addiction in the brain in that
with chronic severe stress there is a
release of corticotropin-releasing
factor which causes a down regulation of
dopamine receptors so essentially
chronic severe stress leads to the same
exact process as addiction it increases
the
thresholds now when we consider that one
out of every four addicts has a history
of trauma that's chronic severe stress
over time we can see that they're primed
for the first time when they use a drug
but that's the first time they're
experiencing any real joy because the
first time anything's crossing their
threshold and then continuing use of the
drug just exacerbates the process and it
becomes a vicious cycle and eventually
old pleasures just don't show up anymore
so addiction is a stress induced hedonic
dysregulation so it's a stress induced
pleasure deafness basically they can't
experience pleasure the other
neurotransmitter I talk about is
glutamate and glutamate is responsible
for memory formation and I always say
glutamates like the executive assistant
of dopamine so anytime you do something
enjoyable and dopamine comes out and
says yeah this is awesome glutamate
comes out and says I'll take note of it
and I'll keep it filed away and so
glutamate will start reminding you of
situations surrounding dopamine release
so you go on vacation in the same place
every year you enjoy it now when you're
packing your back sore that trip
glutamate is going whenever we pack our
bags like this we wind up in Disneyworld
and we like that and there's a lot of
dopamine so you start to get excited
even before you go right
so when addicts use drugs or alcohol in
the same exact place or environment and
with the same people in the same house
they drive down the same street to get
their drugs they go to the same bar
every day to get their alcohol glutamate
is taking know that that's where they
get the most dopamine so even driving
past their favorite bar can cause a
small amount of dopamine release and
trigger them 20 use the three things
that cause relapse in humans dopamine
exposure so go into an ER go into the
doctor getting a prescription for a
medication that releases a lot of
dopamine can trigger a relapse any
exposure heroin addict that goes out and
drinks alcohol at a family picnic gets a
lot of dopamine and suddenly can't
remember why they feel so Restless and
irritable and discontent and why am I
even clean and they wind up relapsing
stress anyone who ever knows an addict
who is
relapsed after a period of time clean
you ask him what happened they say
something stressful dog died wife left
lost my job something stressful happened
and exposure to drug cues people places
and things so running into an old dealer
an old friend used to use with running
into an old relationship where you used
to use these can cause relapse so the
midbrain knows it needs high-level
dopamine to survive how does it motivate
the person to behave in a way that's
counterintuitive to what they know how
does it get a soccer mom to bunt and
shoot heroin how does it get the prom
queen to go out and smoke crack
crazy craving is an active midbrain
that's really all it is the merge brain
is active thinks it's dying so it's
going to send out physiological signals
to the body so that the body thinks I
got to do something to make this go away
so it'll send out physical signals
sweating chills nausea restless legs
obsession tunnel vision inability to
think about anything but the discomfort
that I'm in that is what craving truly
is the craving will then tap into the
cortex and find a reason to use it'll go
into the library that is the cortex and
it will find a past reason that is
enough to make that person want to use
hey soccer mom remember when you have
that herniated just three years ago we
never took care of I think it's really
bad right now I think your pains awful
all right
hey prom queen remember you had social
anxiety in kindergarten I think we have
social anxiety again it's really bad
you're anxious you know you want to
leave the house and the craving the
midbrain will actually bring to the
consciousness these things causing the
person to now have give themselves
permission to want to use something I
can't live in this much pain I can't
live with this kind of anxiety they
don't know that's what's happening all
they know is they suddenly have worse
pain worse anxiety worse stress than
they ever did before and that's when
they start acting the way we see them
act the loss of control lying
manipulating well I have to manipulate I
have to see four different doctors if
none of them are going to treat
I paint we don't see all the other stuff
we don't see the down regulation of the
dopamine receptors or the craving or the
the suffering that's going on we see
this and we think that they're bad
people so the question becomes how do we
fix it how do we bring this cortex back
online well after we get through the
medical part of detoxing them we have to
focus on strengthening the cortex so we
have to change this idea that the drug
is survival that the drug is the only
thing that will keep us alive and so we
have a couple of tasks going on one we
have to remain abstinent because that's
what's gonna quiet the midbrain over
time and two we have to work on coping
skills and stress relief and we have to
work on spiritual growth spirituality in
the frontal cortex is the only part of
the brain that is capable of becoming
strong enough to overpower in a midbrain
so that's why we focus on spirituality
in the 12-step programs and in in most
treatment centers because we know that
that part of the brain has the ability
to overpower a midbrain not religion I'm
not talking about religion talking about
spirituality but coping skills stress
truth the second you use a drug that
releases dopamine you instantly forget
all of your coping skills and stress
release instantly so we have to reteach
those behavioral therapy and 12-step
meetings they work on the frontal cortex
they are strengthening that frontal
cortex which is the ultimate goal in
addiction treatment medications work in
the midbrain okay we need sometimes to
quiet the midbrain because they can take
up to a year for the thresholds for
pleasure to come back down to normal
with just abstinence and most people
can't live a year never experiencing any
joy or pleasure they just can so unless
they're in jail they're probably not
going to make it that year so how do we
accelerate the process well we work on
the frontal cortex the harder we work on
that the quicker the process occurs but
in the meantime we may need to quiet the
midbrain
so the idea of a high-end traditional
therapy 12-step therapy group therapy
behavioral therapy is simply to take a
weak frontal cortex and strengthen it in
the face of cravings in an active
midbrain that's the idea so over time
with abstinence and even with medication
because the medication that we use keeps
us consistent level of dopamine in the
system with overtime that threshold will
move back down now it's friable meaning
that the second it's exposed to dopamine
again it'll move back up okay it's not
even if it took twenty five years for it
to get here in the first place it will
only take one use for it to start moving
back up again
the idea behind medication assisted
treatment is simply to quiet the tiger
in the face of a weak frontal cortex so
I always say that back eighty years ago
when Alcoholics Anonymous was founded
you had a bunch of 65 year-old gentleman
who had been through several career
changes lost their wives their children
they're desperate and they walk into a
room and they sit sit down shut up and
listen and they go alright I'll do
whatever you say because I've lost
everything you know I'll do whatever
today we have 19 year olds who lost
their job at Taco Bell and mom will let
them drive the car anymore they don't
understand desperation how do you get
them to sit into in a room with a bunch
of old guys go and sit down shut up and
listen it's almost impossible unless you
can quiet their midbrain if you can
quiet that craving and keep that under
control they will listen they will do
what you tell them so the medications we
use obviously for alcohol and abuse
Carol now trucks on these help with
cravings nothing really stops drinking
antabuse is a negative reinforcement
they'll throw up if they take this and
then drink alcohol we know negative
reinforcement does not work for a long
term but it may be helpful in the
beginning stages of recovery and the
other ones help cravings which may or
may not reduce drinking for opiates we
replace them or we block them those are
our choices we can replace them which
quiets the midbrain or we can block them
prevents the midbrain from getting them
but the problem with opiate with these
medications obviously is they do nothing
for cocaine or benzos or marijuana or
alcohol and so for not actively working
in the frontal cortex we're not actively
reminding them that they're addicts the
drugs useless and that's what I just
talked about and so basically the idea
behind medication is harm reduction we
have to reduce the amount of harm
they're doing decrease the amount of
overdoses by giving them this medication
saying this is not the treatment this is
simply helping you get to the treatment
so the definition of addiction is
essentially a dysregulation in the
pleasure system a broken reward system
and it results in loss of control which
is that foolish behavior we see the
craving and the persisting use despite
negative consequences something bad
happens you keep using it's a problem
and that is how we get it to fit into
the disease model so the organ is the
midbrain the defect is this
dysregulation of the pleasure system and
the symptoms are loss of control
cravings and persisting use despite
negative consequences and the ultimate
toolbox is really a combination approach
we look at therapy we look at 12-step
groups we look at medication if it's
appropriate and we and we work together
as a team
nobody can treat addiction on their own
nobody not one single person can't do it
you need a team and the only way we're
ever gonna really fix this is to prevent
it so we really need to start at the
level of the adolescents we're now we're
going to treat it to extinction I don't
know how we do that I don't have an
answer for that but that's how what we
have to focus on that's that
yeah a lot of information
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