Causes of Drug Addiction

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Drug addiction is the result of spiritual dislocation

DRUG ADDICTION is not caused by drugs, but by physical and spiritual dislocation of people, a Canadian expert and author on addiction says.

'Everywhere and always, dislocated people are huge consumers of alcohol and whatever drug happens to be around,' said Dr. Bruce Alexander, a professor of psychology at Simon Fraser University in British Columbia. He has spent 20 years researching addiction.

As an example, he said Toronto's growing drug problem follows the increase in immigrants -- those dislocated from their origins. He also warned that Southern Ontario's economic dislocation, caused by the recession, could also result in a future increase in substance abuse.

Dr. Alexander will give McMaster University nursing alumni's Henrietta Alderson lecture in the Great Hall of the Faculty Club at 7.30 p.m. today.

He believes North America's much-publicized war on drugs fails to address the correct cause. History shows us that where people have been dislocated from their physical or spiritual roots, substance abuse has grown. And where there is substance abuse, crime follows.

The theory that addiction to drugs or alcohol is a disease that can be cured by removing the abused substance is a leftover from the temperance era, he says.

Dr. Alexander discusses his beliefs about addiction in his book Peaceful Measures: Canada's Way Out of the War on Drugs. He also served as academic consultant to CBC-TV's The Nature of Things program Dealing with Drugs and appeared on a recent edition of CBC Radio's Ideas.

Dr. Alexander said it was important for caregivers and addicts to realize that while treatment for drug addiction often does not cure the addiction, substance abusers usually find their own way out of their addiction.

Credit: THE SPECTATOR

The Science of Drug Addiction

Drug addiction is a complex brain disorder and should be treated as a medical condition, not a crime, scientists said last week.

A series of reports in the journal Science described what experts know about drug addiction -- its biological basis, what treatments work and which do not.

Alan Leshner of the National Institute on Drug Abuse said that although science has revolutionized the understanding of drug abuse, policy-makers have done little to act on it.

"It is time to replace ideology with science," Leshner wrote. "There is a wide gap between the scientific facts and public perceptions about drug abuse and addiction.

"The more common view is that drug addicts are weak or bad people, unwilling to lead moral lives and to control their behavior and gratifications."

But he said scientific advances in the last 20 years have shown that drug addiction is a chronic, relapsing disease that results from the prolonged effects of drugs on the brain.

Eric Nestler and colleagues at the Yale University School of Medicine said scientists are just beginning to understand the physical changes on a molecular basis.

"Ultimately, a detailed understanding of the molecular and cellular mechanisms of addiction will transform the way society views and treats this illness," they wrote.

The Real Dope On Addiction: After a decade looking for the grail of substance abuse, scientists begin to unravel the complex circuitry of craving;

Some neuroscientists are experiencing what amounts to a natural high. For the first time, they have captured images of the brains of addicts in the throes of craving for a drug, revealing the neural basis for addiction.

The finding caps a decade or more of intensive brain research seeking the grail of substance abuse, the neurological circuitry that compels addicts to pursue the next fix. And the discovery confirms a number of emerging scientific hunches about the neurology of addiction.

For instance, no matter what the addictive substance is - amphetamines, heroin, alcohol or nicotine - all seem to activate a single circuit for pleasure deep in the most ancient part of the brain. This circuit, for the neurotransmitter dopamine, is the site of the high that addictive drugs bring.

And fine-grained studies of brain cells reveal that repeatedly dosing the brain with addictive drugs is akin to a chemical assault that alters the very structure of the neurons in the circuitry for pleasure. These changes starve brain cells of dopamine, triggering a craving for the addictive drugs that will once again swamp the brain with it.

A drumbeat of findings from dozens of scientific laboratories, several within the last few months and as yet not published, herald these conclusions, which ``offer an extraordinary insight into the brain basis of drug addiction,'' said Dr. Alan Leshner, director of the National Institute on Drug Abuse. He added, ``There have been a tremendous number of major advances in the last year.''

The identity of this brain circuit for addiction is a scientific flashback of sorts, if not a hallucinatory deja vu: the same brain area was the focus of intense study as long ago as the 1950s, when psychologists routinely implanted electrodes into rats' brains in the region they then called the brain's ``reward centre.''

After the rats were trained to push a lever to stimulate this centre, they would do nothing else, even forsaking food and water to dose themselves with dollops of rodent bliss - an animal model of addiction. But the specific neural circuitry involved was, at the time, a scientific mystery.

Today that mystery seems to have been solved by using positron emission tomography (PET) scans of the brains of patients being treated for cocaine addiction. Reports from three different laboratories using PET scans show that when addicts feel a craving for a drug, there is a high level of activation in a strip of areas ranging from the amygdala and the anterior cingulate to the tip of both temporal lobes.

This mesolimbic dopamine system, as it is called, shows heightened metabolic activity ``when people are in a profound state of craving for cocaine, primed to seek it out and take it,'' said Annarose Childress, a neuroscientist at the University of Pennsylvania who did one of the PET studies. The same system seems to be ordinarily in play to provide a sense of pleasure in whatever people find rewarding, like sex or chocolate or a job well done. Dopamine may also be part of a reward system in creatures as different from humans as bees, other researchers have shown.

In Childress's study, PET scans were done on patients under treatment for cocaine addiction while the patients were being exposed to cues that had made them crave cocaine in the past -- like seeing a videotape of people taking cocaine or handling crack pipes or other drug paraphernalia. Drug treatment programs routinely caution patients to avoid such Pavlovian cues, which addicts have learned to associate with the drug high itself, because the cues have long been known to trigger the craving for the drug.

The PET scans showed activation in the mesolimbic dopamine system as the addicts described feeling intense cravings for cocaine.

The mesolimbic dopamine system connects structures high in the brain, especially the orbitofrontal cortex, in the prefrontal area behind the forehead, with the amygdala in the brain's centre, and with the nucleus accumbens, a structure that in animal research has proved to be a major site of activity in addiction, although in humans it is about the size of a squished pea, too small to register in PET images.

The ultimate source of this dopamine system is the same brain region where psychologists stuck electrodes decades earlier to make rats endlessly stimulate themselves for pleasure, a location called the ventral tegmental area.

These brain areas have emerged in the last several years as hot spots in research on every addictive substance studied, and some that create dependency, if not strict addiction. Last month, for instance, Italian researchers reported in the journal Nature that the mesolimbic dopamine system was active in nicotine addiction, adding tobacco to a roster that includes heroin, morphine, cocaine, amphetamines, marijuana and alcohol.

In addiction studies with lab animals, a main site of activity is the outer layer of the nucleus accumbens. In humans, a nearby interconnected structure, the amygdala, ``is more important in craving,'' said George Koob, a neuroscientist at the Scripps Institute in San Diego. ``If people have a lesion in a section of the amygdala, they no longer link pleasure to its causes - they wouldn't experience a favorite food as enjoyable,'' he said.

What ties years of brain research on addiction together in a ``final bow,'' Koob said, is the new finding by Childress and others that ``what lights up during craving is the temporal lobe, particularly the amygdala, where all these pathways converge.''

The various brain pathways he is referring to all have a particular kind of cell that has the D2 dopamine receptor, which is distinct from other dopamine receptors, like those involved in Parkinson's disease. PET images of cocaine patients taken over several weeks after they stop using the drug show a drop in those neuronal activity levels that is consistent with a lessened ability to receive dopamine.

Although the degree of this reduction lessens over time, it is evident ``even a year and a half after withdrawal,'' said Nora Volkow, director of the Division of Nuclear Medicine at Brookhaven National Laboratory on Long Island. She has also done some of the other recent PET studies.

This pattern of reduced brain activity directly reflects the course of the craving.

``The highest risk of relapse for cocaine addicts is during the third and fourth week after they've stopped taking the drug,'' said Dr. Joseph C. Wu, a psychiatrist at the University of California at Irvine who has made PET images of cocaine addicts that verify the other reports. ``You see the lowest levels of activity in the mesolimbic dopamine system during that time.''

The brains of addicts are almost back to normal after a year without the drug, though not completely, he said. ``If you can stay abstinent for about a year,'' Wu said, ``you've weathered the periods of greatest vulnerability.'' Scientists are still debating whether the dopamine cells ever fully return to normal.

The gross patterns of brain activity detected in PET scans represent changes at the microscopic level that are so dramatic that they are akin to the kinds of changes that result from a brain injury, in the view of Eric Nestler, a neuroscientist at the Laboratory of Molecular Psychiatry at Yale University School of Medicine.

In an anatomical study of dopamine cells in rats that had become addicted to morphine, Nestler's team found that the neurons with D2 dopamine receptors had become 25-per-cent smaller and had lost much of their ability to receive dollops of dopamine from nearby neurons.

The afflicted neurons also underwent a drastic change in their internal dynamics, altering the workings of the so-called second messengers, proteins like cyclic AMP. After a molecule like dopamine latches on to a receptor on the cell surface, the second messenger acts within the cell to coordinate its response, like the release of neurotransmitters to signal other neurons.

``When you take a drug like cocaine, it floods the neurons with levels of dopamine never seen in nature,'' Nestler said. ``The addictive drugs have an impact on the dopamine circuitry like a sledgehammer, storming through this pathway with an intensity that never occurs ordinarily. Taking drugs over and over perturbs these systems, and they try to adapt by making the dopamine less effective.''

Once the cells adapt this defensive manoeuvre and become less responsive, the cells are left bereft of normal levels of the neurotransmitter if a person stops taking a substance that floods the mesolimbic systems with dopamine. These changes seem to be the neural engine driving the craving for more of any drug.

``You find the same changes not just with cocaine,'' Volkow said, ``but also with other addictions, such as to heroin and to alcohol,'' although each drug affects the dopamine system through distinctive neural routes.

The shift to addiction seems to occur as dopamine deprivation produces chronic unpleasant feelings, depression and a loss of motivation, which leads to the need to take the drug to feel better.

``Once these cellular changes occur,'' Nestler said, ``addicts will take a drug just to feel right, not for a high.''

What does all this portend for the treatment of drug addiction? ``The research suggests a common biological essence to all addictions,'' said Leshner, of the National Institute on Drug Abuse, ``though I don't think we'll ever have a single magic bullet. We might instead one day have neurochemical cocktails that are specific to each addictive drug that would break the cycle of craving.''

Brain Region Linked to Addiction

Researchers at McLean Hospital in Boston have identified an area of the brain that appears to play a key role in why cocaine and other stimulants are highly addictive. Researchers found that the cerebellar vermis, which is involved in other psychiatric illnesses, appears to play a role in drug addiction. The study involved reviewing published data on the vermis that had not been analyzed for the vermis' involvement in addiction. In the original 1998 study, researchers used functional magnetic resonance imaging (fMRI) to scan the brains of 10 individuals addicted to crack-cocaine as they viewed a video of people lighting up a crack pipe. Compared to a control group of non-users, users reported an increased desire for cocaine following this cue and had increased activity in several brain areas, including the anterior cingulate cortex.

The new analysis shows activation in the vermis in cocaine users while they viewed the cocaine-use video. As part of the investigation, researchers also reanalyzed data from an unrelated study which found distribution of a drug that targets the dopamine transporter, the protein that seems to be blocked by such stimulants as cocaine, through the use of positron emission tomography (PET). The new data show, in non-drug using participants, that the vermis may contain dopamine transporters and thus may be a target for cocaine and other stimulants, thereby increasing dopamine in the brain. The researchers suggest that if the vermis plays a key role in the brain's dopamine system, this could explain its role in addiction, as well as in other brain disorders, such as Parkinson's disease, which is characterized by a shortage of dopamine.

Drug Addiction Destroy his Music Career

There are three songs Vancouver musician Ted Rich has on a demo tape he wants his newfound half-brother Eric Clapton to hear.

But before sending his superstar sibling any of his music, Rich, 38, knows he has to first kick his six-year heroin addiction.

"I've got three songs I've written that I'd like to send to Eric Clapton to let him hear what his brother's music capabilities are," Rich said at the home of a friend who is helping him try to straighten his life out.

"It's no secret, I'm wired, but that doesn't make me any less of a person," he said. "All I want to do is get a monkey off my back so I can get on with my music career."

During the '80s Rich was a well-known local musician praised for his guitar-playing and song-writing talent.

Then, about six years ago, his life spiralled out of control as his heroin addiction took him on a roller-coaster ride into the dark world of Vancouver's skid row.

"I had a career that was going pretty good," said Rich, still taken aback by all the media attention focused on the fact he comes from the same stock as Clapton. Clapton, a legendary rock and blues guitarist, and Rich share the same father -- a former Canadian soldier and drifter named Edward Fryer.

Stationed in England during the Second World War, Fryer met Clapton's mother and the guitar legend they call Slowhand was born during the wartime romance. Rich's mother Cecilia Rich is a music teacher living in Surrey. She met Fryer after he returned from the war and the two had a musical act that took them all over North America.

The two brothers share a love for music and both understand the danger of addiction. Clapton kicked heroin and also battled the bottle.

Rich hasn't been so lucky.

"I got as big as you can locally but in that situation heroin appeared. The habit took over my career and I sold my last guitar to keep myself and my girl wired on heroin."

With absolutely no hope of kicking heroin on his own, Rich says he has to get into a treatment centre to try to get his health back. "I'm trying to get into a drug rehab clinic. But drug rehab in this province is absurd. There is nothing set up and you can't get in."

When Rich was told April 1 while in jail on an outstanding warrant that Clapton was his half-brother, he first thought it was an April Fool's joke. Then the truth sank in.

"For two days I was walking around going 'Layla'," he said.

Still, Rich wonders if his self-destructive lifestyle will send his half-brother running.

"Eric Clapton is going to hear all these horrifying stories and any chance I had of meeting him may go down the tubes," he said. "I'm going to write him a letter saying this is who I am and where I'm coming from."

But first he wants to be clean and sober.
Exposure to metals may lead to alcohol and drug addiction

Exposure to certain metals may do more harm than previously thought.

Lead and cadmium appear to make people more susceptible to alcohol and drug addiction, says Jack Nation, a psychologist at Texas A&M University.

"You have an unhappy situation where our chemical environment may be altering patterns of drug use and abuse," says Nation, who has spent 15 years studying the effects of environmental contaminants on drug use.

Cadmium, a component of cigarettes, enters the body when someone smokes, and it stays for decades, Nation says. It also enters fetuses when mothers smoke during pregnancy.

A common exposure to lead comes via old paint, making children in poor neighbourhoods especially vulnerable. A 1999 study warned that 70 per cent of children in major metropolitan areas might be at risk of dangerous exposure to lead.

The warnings in the latest study stem from the researchers' tests on rats.

Exposure to lead changed how the rats in the study reacted to the effects of cocaine, Nation says.

The processes that cause drug addiction in rats appear similar to those in people, Nation says. And, unlike other drugs, he says, cocaine packs a bigger punch as people use it more often, which makes it especially addicting.

The rats were allowed to self-administer cocaine by pressing a lever that sent the drug into their jugular vein, he says. While initial doses of cocaine didn't do much for the lead-exposed rats, the animals actually became "supersensitive" to later doses, he says.

Exposure to cadmium, on the other hand, made the rats more tolerant of the effects of alcohol and drugs, the study says. Results appear in the October issue of the journal Neuropsychopharmacology.

In some people, higher tolerance to drugs and alcohol could keep them away from addiction because they won't get much of a kick from their first doses, Nation says. But others might face greater danger because they'll need to take more drugs to get their desired high, he says.

"What we're talking about are cases where you have people who are going to use drugs because of their life circumstances," he says. "They're going to have to opt for a higher dose."

And those higher doses will pose greater harm to their bodies, he says.

The two metals -- lead and cadmium -- appear to change the way the chemical dopamine works in the brain, Nation says. Scientists suspect dopamine is a major player in addiction because it regulates positive feelings, like euphoria, that can accompany a drug-induced high.

However, not everyone is convinced that a definite link exists between lead, cadmium and increased drug abuse.

Ron Kuczenski, a psychiatry professor at the University of California, San Diego, says it's clear that lead affects the way dopamine functions in the brain. But, while lead exposure changes the way a body adjusts to drug use, that doesn't automatically translate into greater likelihood of addiction, he says.

And it's far from clear whether greater tolerance for a drug will make someone more likely to become an addict, Kuczenski says.

Credit: Healthscout.Com
Addiction researcher warns of drug risks

A top American clinical researcher in the field of drug addiction warned Tuesday that decriminalizing marijuana could lead to increased abuse of the drug.

Studies show wider availability of a drug coupled with a relaxed attitude towards it help predict the level of use and addiction, said Dr. Nora Volkow, director of the National Institute on Drug Abuse.

Volkow said surveys indicate that if a drug is considered safe and benign, its use spirals. Drug addiction rates can range from 20 to 30 per cent of users.

"The notion of legalizing and making drugs accessible, what it will do is ultimately increase the number of people that get exposed to the drug," Volkow said in an interview. "Some of those people will become addicted that may have not become addicted had it not been so easily accessible."

The best examples, she said, are alcohol and tobacco, both widely available and relatively acceptable socially and with the most widespread addiction rates. The federal Liberal government is mulling the decriminalization of possession of small amounts of pot. The Canadian proposal is drawing frowns within the U.S. government - - notably drug-policy czar John Walters -- accompanied by warnings about implications at the border.

Volkow, here to speak to people working in the drug-addiction field, said many scientists used to believe marijuana was not addictive. But she said the pot consumed by the Baby Boom generation had much less of the active ingredient THC -- which interacts with receptor proteins in the brain that translate pleasure responses -- than the types now available.

"It is this chemical that can lead to the addiction," she said.

"When people were taking marijuana in the past, they were consuming a very weak drug.

"The experiences that people may have had -- that are now in their 40s and 50s -- who say `I never became addicted to that drug,' that does not necessarily pertain to the type of compound we're seeing today."

Research since then has also revealed a lot more about the effects of marijuana on those brain receptors and how they help regulate things such as memory and learning, she said.

Volkow was appointed in 2003 to head the institute, an arm of the U.S. National Institutes of Health.

With a budget of more than $900 million US, it is the world's largest supporter of clinical research on addiction and funds about 85 per cent of studies worldwide.

A research psychiatrist, Volkow, 48, has published more than 200 papers and specializes in the study of brain imaging to investigate what role dopamine, the brain chemical that triggers sensations of pleasure and motivation, plays in addiction.

Volkow's skepticism about marijuana is based partly on her experience.

She made her reputation in the 1980s with a ground-breaking study that discovered regular cocaine use caused tiny strokes. Coke was the drug of choice in the go-go '80s, popularly thought to be safe for recreational use.

"I had serious trouble getting that study published," she said. "Nobody wanted to believe it."

The organization Volkow now heads even rejected her grant application. It took the cocaine deaths of two prominent sports stars to alert people that maybe cocaine wasn't so safe, she said.

Those kinds of causal links don't yet exist with pot, she said. But some studies have tied its use to a rise in psychotic episodes and schizophrenia.

The institute is funding research to look at the effects of marijuana in the developing brain.

Volkow told the meeting research indicates adolescent brains are at higher risk of drug addiction because areas of the frontal cortex that affect reasoning and judgment, as well as a deeper region that involves pleasure responses, are not yet fully developed.

A Visit to the Hell of Addiction

Fix may be one of the most disturbing yet at the same time empowering documentaries ever made on drug addiction.

And award-winning B.C. filmmaker Nettie Wild has only begun to explore the subject.

"I wanted to look at the issue and then go back and write a dramatic film script," Wild says.

"There is a certain point at which the documentary film camera has to stop," the director says. "At that certain time you have to fictionalize to discover the truth."

Fix is a brutally honest account of hard-core drug addiction on the streets of Vancouver's Downtown Eastside and the struggle for adequate treatment and harm reduction.

People will be shocked by some scenes -- one, for example, offers a twisted perspective on humanity as an addict sympathetically injects heroin into the jugular vein of a fellow addict lying prostrate in a back alley -- in the award-winning filmmaker's latest work.

Some audience members may even walk out of the theatre in disgust. Still others will have their eyes opened to a reality that this province has for too long neglected at a cost of untold thousands of lives.

They will have a chance to experience the newly released documentary and explore the issues surrounding the film in a series of two screenings and public forums set for Wednesday and Thursday at the Paramount Theatre.

Community workers with awareness of the drug problem in Kamloops will speak at the forum along with former Vancouver mayor Philip Owen.

As with many hard-hitting documentaries, Fix has an organic, hand- made feel to it, as though it were shot on the fly in a single afternoon instead of being a two-year production.

Much of the potency of the story is owed to the subtext about two relationships.

"The key is finding access to a character who will allow you in and allow you to film when they're vulnerable as well as strong," Wild says.

Fix has not one, but three such characters who bare their souls for the camera.

Dean Wilson, a former IBM salesman, is an outspoken addict and president of the Vancouver Area Network of Drug Users. He tries repeatedly but cannot shake his addiction to heroin.

Owen becomes a most improbable ally in the struggle for a four- pillars approach to drug addiction (treatment, prevention, harm reduction and enforcement by/co-operation with the police).

"We would always keep the camera rolling even when these characters appeared contradictory," Wild says.

Then there is the enigmatic Ann Livingston, a radical, Christian street activist and single mother, and her on-again-off-again romantic relationship with Wilson.

"I think you are dealing with someone who walks the talk," Wild says of the Livingston. "She really believes that, as a spiritual person, before anyone can heal the sick they have to start showing compassion."

It is that collective mindset -- of viewing drug addicts as something less than human -- that the film questions.

"Together they have built a momentum in that we can see a political and social movement taking shape."

The camera is close, so close to the drama at times that it seems to be engaging the action instead of merely recording it. Yet Wild - - whose earlier documentaries have included A Rustling of Leaves: Inside the Philippine Revolution (1989-90), Blockade (1993) and A Place Called Chiapas (1998) -- knows well the territory of her trade.

"There is this invisible line over which I cannot cross. At no time do I suggest what people should be doing or take suggestions about what we should be filming. You can never do that."

A Rustling of Leaves won People's Choice at the Berlin Film Festival and A Place Called Chiapas won a Genie for Best Canadian Feature Documentary. Fix was judged Most Popular Canadian Film at the Vancouver International Film Festival last year.

"My role was to be there to document and this is their story. It's about being a filmmaker, holding a mirror up to a social movement being born."

Wild is ready to leave that objectivity behind in order to delve deeper into the subject matter, though.

"I want to find that side of Ann Livingston that the documentary doesn't."

Drug Addiction Rate Rising

The drug addiction rate among Toronto teens is rising so fast there's not enough money for everyone who asks for help, according to a new report.

Teens under the age of 17 accounted for more than 35 per cent of all addicts treated through city programs during a six-month period, according to Toronto's Youth Profile released Thursday.

Requests for help were up 12 per cent between 1997 and 1998, the report says, resulting in youth spending between four and five months on a waiting list before getting help.

The city's youth programs took a $10 million hit through amalgamation three years ago.

Besides drug use, the report said that teenage homelessness, pregnancy and violence are also on the rise.