To all my friends

I would like to share some of what I have learned about addiction, and I hope that my message will resonate with some of you. My doctor taught me a lot about the medical basis for addiction.

One of the problems we have faced is that for many years addiction has been viewed as a character flaw, as a weakness, and as a choice by those of us who have become dependent on substances such as alcohol and prescription pain medications. The major substances that lead to addiction besides alcohol include nicotine, opiates like Vicodin, codeine, Norco or heroin (whether smoked, snorted or injected), stimulants like the various forms of “speed” (amphetamines, methamphetamines, Ecstasy, diet pills) and sedatives like Valium, Ativan, Klonopin, Xanax, barbiturates, or GHB. And this is just a short list!

Years ago depression was viewed as a personal weakness, but then it was discovered that it was a disease in which there are low levels of certain neurotransmitters in the brain. Serotonin is one of the major neurotransmitters that is deficient and by taking a serotonin enhancer, e.g. Prozac, depression can be treated successfully.

Similarly, addiction has been viewed as a personal weakness or character flaw, but research points to abnormalities in another neurotransmitter, dopamine, as one of the major reasons behindthe cravings, the loss of control, and the continued use of drugsin spite of adverse medical consequences. The director of theNational Institute on Drug Abuse, Dr. Alan Leshner, has called addiction a brain disease. There are many risk factors for substance abuse and addiction. In describing the change from voluntary use to the compulsive behavior linked with intense craving he says. “It’s as if a switch has been flipped on and there is now a brain disease.”

My doctor has explained to me the important role of genetic predisposition to addiction. Apparently, there is not a single gene but many genes responsible for the changes that occur in the brain in addiction. Many people who become addicted can identify parents or relatives who have had drug problems. That is because some, but usually not all, of our blood relatives have inherited combinations of genes that put them at risk for addiction . It may even appear that the disease has skipped a generation. That is due to how one’s chromosomes have recombined to produce the egg or sperm. We are the ones who received just enough of the genes to lead to the abnormal response to drugs in a very important and primitive part of our brain called the mesolimbic circuit, the dopamine reward pathway. This very basic part of the brain is the “feel good” circuitry and is what keeps us feeling normal and happy. However, exposure to substances of abuse, whether it is alcohol, speed, opiates, or tranquilizers, can-over time- lead to abnormal brain responses in this mesolimbic reward pathway. Perhaps lower than normal baseline dopamine levels is what leaves us with that terrible, empty, irritable feeling that makes us crave using the drug again to escape that abnormal feeling.

So why not just give us a dopamine enhancer? Well, my doctor tells me that trials are underway looking at medications that might help, but so far there is no medication in which the benefits outweigh the side effects.

Now one last very important point. It appears that stress can trigger relapse! The molecular mechanism involves a brain hormone called corticotropin releasing factor. It’s a big word and an important reason why so many times an argument with a loved one, a setback or criticism at work, or an illness in the family, for example, can cause us to crave our drug again. We must be prepared to deal with the stresses of our daily life without drugs. How do we do this?

A 12-step fellowship helps provide a structured, safe environment in which recovery can take place. All of us who have lost control and have a compulsion to use a drug feel embarrassed, ashamed, and guilty about our behavior. We need a non-judgmental setting in which we can feel accepted; recover our lives and spirit in a loving and supportive group. I encourage all of you who have a similar problem to please seek help. (If you think you might have a problem you probably do.) This is an affliction of the body, mind and spirit; and once the physical craving is removed (detox) there is a spiritual solution. Admitting you are powerless over the drug is the first step towards recovery.

Sending all my newly detoxified love and light, and lots of thanks for al of the beautiful messages…

Happy Thanksgiving to all!

With big love,

Melanie