New Medical Information About Addiction

By: Michael Stone, MD, Addiction Medicine Specialist,
Director, Cornerstone of Southern California

Hopefully you have read my two previous articles on this subject and have a good or better understanding of what addiction is and how you or someone else got it. This article will give you a clearer understanding of this brain disease and perhaps make it easier for you to accept the disease as real. You should also know I believe that it is not an addict's fault they have the disease of addiction, but it is their total and absolute responsibility to do something about it once they know that they have it.

They need to be open and hear what others (family, friends, peers, employers, legal system, and medical system) tell them. They must investigate and allow themselves to learn more about this disease they are told they have. Hopefully they will then know they have the disease, work on acceptance, and finally surrender to the program of recovery.

To make this process easier, the following discussion of some of the new medical information in the area of addiction and brain chemistry should help.

Deep in the brain is an area I call the "feeling center." Here the cells talk to each other by sending messages across the spaces between them. These messages are in reality chemicals called "neurotransmitters." There are many of these neurotransmitters, but five of them have been found to be important to addiction in general. There is a sixth one involved in nicotine addiction that may be a topic in the future.

Neurotransmitters were only discovered around 1970 when researchers found the chemical messengers for pain relief. These are endorphins and enkephalins. A little later it was found that these messengers worked by being released by cells in the brain, floating out and randomly hitting the surrounding cells. The surrounding cells had little pockets on them called "receptors" and each of the messengers, having its own specific shape, only fit into its own specific receptor. Whenever a messenger hit and locked into his receptor, the message was then transferred to the new cell.

The neurotransmitter messengers we mostly hear about are the dopamines, norepinephrines (adrenalin), serotonins, endorphins/enkephalins, and G.A.B.A. (gaba amino butyric acid).

Now you have to realize I am very much oversimplifying this information, but it is not necessary for you to have a neuro-pharmacologist's physiological understanding of all this to realize that there is a brain chemistry basis for addiction. I want you to get a good feel for how it works, so bear with me as I try to explain, simply, a very complicated area of medicine unknown even to many doctors.

I want to go back to the "feeling center" of the brain. This center has a lot of involvement in your general mood (how you actually feel at the moment is controlled by the "feeling center" - sort of obvious, eh?). It also controls our many "drives" - appetite drive, sex drive and performance drive. You will hear medical names attached to this area - central brain, limbic system, and hypothalamus.

When we smell good food cooking etc., some special cells in the "feeling center" send off a blast of neurotransmitter messengers and we "feel" hungry and are "driven" to find and eat food. The same happens when we think about sex or are stimulated to become sexual - a blast of neurotransmitters are released.

Most of us have an interest in doing whatever we do - well. This is our performance drive. Having drives is normal. Feeling hungry, being interested in sex, wanting to do things well and wanting to be in a good mood are totally normal and expected drives.

The disease of addiction occurs when the feeling centers' nerves and neurotransmitters are changed, causing addiction. As I have previously said, you can be born with these changes in place or with a genetic predisposition to having these changes. As you cannot change your family of origin - parents, grandparents, etc. - it is not your fault if you were born an addict or with an overwhelming predisposition to becoming an addict.

As well as the drives and feelings, the "feeling center" controls behavior in 3 other important ways:

- It controls how stimulated "up, energized, positive, strong" you feel and the neurotransmitters involved here are the dopamines, norepinephrine, and stimulating serotonins.

- It controls how relaxed "pain-free, numb, down" you feel and here the neurotransmitters are the endorphins/enkephalins (opiate, pain-killing, numbing effects), G.A.B.A. (sedating, relaxing, tranquilizing, sleep-causing effects), and sedating serotonins.

- It also controls how we perceive the outside world and this is also controlled partially by specific serotonins. This area is a little harder to understand, but let me say that when the "feeling center" is working normally we perceive (see, feel, smell, hear, and taste) the outside world and get a fairly clear picture of the way the world is at the moment. This is what is real and it is real to us and would be basically the same for any other normal person in the same situation.

When this area of our "feeling center" is changed by addiction, then we would get "high" on behaviors or drugs that would significantly change how we "perceive" the world - drugs like PCP, L.S.D., peyote, mushrooms, marijuana (mild effect) and other hallucinogens - perceptual changing drugs. You might have noticed from the above discussion that serotonins are very involved in how we feel, affecting all areas; stimulating, relaxing, and perception-changing. This will be enlarged upon next month. I will close this session by reminding you to read the Article "Brain Chemistry of Addiction" that will complete my ideas in this area of addiction. Hopefully it will all come together in a fairly clear summary, leaving you even more comfortable in your understanding of the "disease" concept of addiction.

MICHAEL STONE, MD, Addiction Medicine Specialist
Cornerstone of Southern California

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Addiction the Disease

How do you know if you have this disease?

How do you know if a loved one, a colleague, an employee, a friend, or your cellmate has this disease? There are endless definitions but here is mine. There are five pieces of the puzzle and all have to be present to be sure it is an addiction.

First - compulsion. This is not all the time, it is not every day but it is obvious. The cocaine addict gets the urge to use cocaine, the alcoholic craves a drink and the Vicodin addict is driven to get the pills. Addicts get the compulsion to do "it" (what they are addicted to) ...

Second - they do "it". I believe it is possible to be an... Read More »

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Incidental Medical Services (IMS)

On January 1, 2016, Chapter 744, Assembly Bill 848 was enacted authorizing adult alcoholism or drug abuse recovery or treatment facilities that are licensed by the Department of Health Care Services (DHCS) to provide IMS. AB 848 amends sections 11834.03 and 11834.36, and adds sections 11834.025 and 11834.026 to the Health and Safety Code to allow licensed residential providers the option to apply to DHCS for approval to provide IMS in their facilities.

IMS are services provided at a licensed residential facility by a health care practitioner that address medical issues associated with either detoxification or the provision of alcoholism or drug abuse recovery or treatment services to assist in the enhancement of treatment services. IMS does not include the provision of general primary medical care. IMS must be related to the patient's process of moving into long-term recovery.

The following six categories of IMS services may be provided after receiving approval from DHCS:

  • Obtaining medical histories.
  • Monitoring health status to determine whether the health status warrants transfer of the patient in order to receive urgent or emergent care.
  • Testing associated with detoxification from alcohol or drugs.
  • Providing alcoholism or drug abuse recovery or treatment services.
  • Overseeing patient self-administered medications.
  • Treating substance abuse disorders, including detoxification.

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