College students are seeing high rates of depression and suicide, ever greater use and overuse of alcohol, and now the addition of common prescription drugs like the stimulants used for ADHD, anti-depression benzodiazepines, synthetic opioids, to accompany the and much more potent marijuana and heroin. We discuss issues of self-medication for depression, stress, isolation factors, strangely including Facebook and other neo-social context changes. PODCAST
Transcript (edited):
HOWARD: Welcome to the CNS Podcast featuring Dr. Darryl Inaba, research director for CNS Productions I am HOWARD La Mere. Today is Valentine’s Day, and just a brief note that chocolate really can be addictive. We’ll revisit that later if we have time, but first let’s talk about attention deficit disorder about new information that contradicts popular wisdom. Also there is a new reality show that debuted called “My Weird Addictions”, or something like that. There was an article about a woman who was on the show who has been eating cat fur for 15 years. But, Darryl, let’s talk about attention deficit because that sounded kind of interesting.
DARRYL: Actually, Howard those are all interesting topics and I wouldn’t mind weighing in on some of those, but just the ADHD research that was just published by the University of Pittsburg. I think the total number of subjects that they followed for quite a long time, longitudinal study, to see whether or not the condition and especially the use of the stimulant medications, Adderall, Concerta, Ritalin and a variety of stimulants, are conducive to future addiction when they are prescribed to a young person. And of course, we’ve talked on this before and the dearth of the research that’s been published and produced to date anyway, has really supported the pharmaceutical industry in saying that although these are addictive substances, addictive amphetamine, and addictive stimulant substances, that their appropriate use in people with appropriate diagnosis of attention deficit hyperactivity disorder, that’s where they are most studied, but also it’s also attention deficit disorder as well which is the non hyperactive type or the spacy type, but these medications when used specifically for those disorders actually decrease the likelihood that somebody will go on to future addiction and that’s a contradiction to the current feeling that age of first exposure to an addictive drug is the best correlate or the best predictor of future problems with drug and alcohol.
HOWARD: Seemingly across all drugs.
DARRYL: Exactly. It’s a person’s first exposure to an addictive substance that passes through the addictive pathways in the brain and also impairs the development of the frontal cortex which is the reason it’s very predictive of future drug use. But this study is very different. This is the first major study that tracked approximately 500 children from the age of adolescence to beyond, and found that, yes indeed, these children who were diagnosed with ADHD and put on psychotropic stimulant drugs had almost double the rate of addiction and related problems compared to children who weren’t diagnosed or put on those drugs. Whether it’s the diagnosis itself or the drugs, they didn’t say, but this contradicts previous studies reporting that if you use these medications, then you’re going to have less addiction. And I think that’s important because we should always closely look at research and who is supporting that research and where it’s coming from this scrutiny is important to get a true picture and the true meaning of what’s happening. I would suspect that using these medications on an adolescent mind, a brain that has not yet fully developed would increase its tendency to addiction, but that’s just a projection and this is the first study possibly confirming that projection. In addition to that, there was feature in the New York Times, I believe, about a father whose son was diagnosed for ADHD and then put on Adderall. The father watched in horror as his son grew up to be horrendously addicted to various drugs.
HOWARD: To meth in particular?
DARRYL: No, to alcohol, meth, to a variety of drugs. This is an example of the fallacy of the claims by all the pharmaceutical sponsored studies which report these drugs protect a person from becoming an addict.
HOWARD: The use of these drugs for attention deficit disorder has been around for awhile, so there must have been clinical studies along the way that validated that they were somewhat safe, were there not?
DARRYL: Yes and that’s what I’m saying. Most of the previous studies insisted they were safe and that they actually protected a kid from developing future drug problems. But, again the studies were paid for and commissioned by the pharmaceutical industry which had a vested interest in selling these very popular medications. We went through an era of prescription stimulant abuse during the 1960’s when these drugs were prescribed for weight loss, they were used to by college students to stay awake concentrate, to study. There is a strong acceptance of these drugs by parents who want their children to be good students and excel in school. For kids who aren’t doing so well in school, these medications help them raise their grade point by quite a bit because the kids feel awake, alert and they can study. So, with that pressure, the drugs were promoted as safe. This is one study that shows the opposite is true and we have to wait to see if other studies can collaborate that
HOWARD: Well, it is interesting that it would take so long for a contradictory finding to show up. Your comment reminded me that prescription drug use, excessive use and abuse, does, in fact, go back to the 1960’s, remember that old movie, Valley of the Dolls which featured the widespread use of Darvon and depressants for mood control as well as the use of various speed, meth compounds for weight control. So, maybe we shouldn’t be so surprised and act like this is a brand new deal, this prescription drug epidemic because we’ve been building on it for awhile.
DARRYL: It’s a replicating story and phenomenon in this country and it actually dates back further than that. If you recall, it goes back to the mid 1800’s or 1860’s anyway when there was a complete patent medicine era.
HOWARD: Yes patent medicine.
DARRYL: And they weren’t prescription. They were patent medicines sold for a bunch of ailments and contained mainly opiates. They were abused and there was widespread misuse in the United States. During the 1940’s is when it all started with not just amphetamines, but barbiturates and “mother’s little helper” and tranquilizers and stimulants and things to help you get through the day and solve all the problems along the way. It was an era of misuse of prescription drugs which probably brought about a lot of the more recent laws to control drug abuse. One of the unintended consequences of being more effective and monitoring and decreasing misuse of drugs is that the population interested in drugs are going to illicit drugs and so we see heroin replacing Oxycontin and Vicodin drugs that are harder to get, more diversion proof, and more difficult to cook down and to inject. So, this is a continuous saga. Pharmaceutical companies have learned that if you sell a substance that is addictive it can be disguised as therapeutic and non addictive, but if it is addictive, then there will be a huge market for it. Just look at nicotine and tobacco.
HOWARD: Because people keep getting addicted.
DARRYL: Right. Well, once addicted you’re going to do whatever you can to keep getting the drug and you’ll pay that bill rather than paying a bill for medical treatment for something. So, it’s a concern that’s going to continue, I believe.
HOWARD: Now, there was something else you wanted to talk about brain shape. I think we might have mentioned this in the last week or two, but it is kind of interesting.
DARRYL: Well, it’s interesting in that it’s merely confirming what we’ve said here at CNS for a long time about addiction, that there are components of the brain circuitry or the addictive brain pathway. One of the pathways that garnered interest worldwide was the reward/reinforcement or the survival/reinforcement pathway. The “go switch” and the nucleus accumbens which is located in the primitive mesocortex, the unconscious part of the brain. But just as liable for addiction is the fact that the frontal cortex, the control area of the brain acts differently and is impaired in somebody prone to an addiction. Basically you have an overactive go switch and an underactive stop switch and studies show a link between cocaine addiction and the shape of the brain. They’re not actually talking about the shape of the skull, which is evident by looking at a person’s head, but the shape of the brain. CAT scans and MRI scans and x rays show that a smaller frontal cortex, a smaller control area where the stop switch is located is predictive of cocaine addiction, which means that a person may have an overactive go switch or might have an average active go switch, but its ability to control that by the executive decision making areas of the brain, the frontal cortex is impaired and the person cannot stop once the go function has been initiated which confirms what we’ve been doing for a long time. I like seeing articles that seem unrelated to what we’ve talked about then confirm our theories on the go and the stop switch. I would like to see more articles and I’ll keep looking for them. The stay stop area of the brain involved with decision making in the neocortex can be very predictive of whether somebody is a chronic relapser, an average relapser, or somebody who is able to go through treatment and enter into recovery much sooner.
HOWARD: And I think that would be valuable information to have a good perspective on who is likely to be more successful in recovery and more or less likely to relapse. We’ve got a little bit of time left. What do you want to say about chocolates?
DARRYL: Well, Howard.
HOWARD: We all love chocolate, but you know this is like THE chocolate day, Valentine’s Day.
DARRYL: It’s Valentine’s Day and certainly it seems to work so well. You bring home some chocolate in a little heart shape box from See’s and it goes a long way towards preserving and continuing your marriage for awhile. And it seems that women, I don’t think has been researched but it seems that women are much more appreciative of chocolate and more prone to be impressed by it than are men. But now there is much talk about the chemistry of chocolate. Is there a chemical reality toward addiction? Most of the experts feel that it’s basically not a true addiction. I mean it can be to a very, very rare person who has great hypersensitivity to it, but for the most part, it’s just something that make somebody feel good, something that alters brain chemistry and brain feelings, but not something that you’re going to trade a body part for or rob someone for it is rare that someone develops an obsessive compulsion over chocolate and continues to consume it despite catastrophic consequences which is the classic definition of all true addictions. I have seen some very, very obese people who are morbidly obese and are basically dying from their inability to control their intake of food who have been unable to control their intake of chocolate, but it wasn’t just chocolate. It’s also high fatty foods and high sugar foods that they’ve been unable to control.
HOWARD: And that’s what chocolate is, basically a high fat, high sugar, tasty treat.
DARRYL: Well, it’s more than that, which is why chocolate is intriguing. We all know it contains caffeine as well as a form of xanthine called theobromine and this combination seems to provide more dopamine release, more serotonin release, more feelings of well being and euphoria stimulated not as high as cocaine certainly, not as high as methamphetamine, but certainly above normal feeling of elation. So because of that there are some concerns. There have been reports that it contains phenethomines ecstasy is a phenethomine and many of the new age designer psychedelic drugs are phenethomines so they are implicated in the psychic aspects of chocolate. Chocolate releases dopamine which is the reinforcement chemical which some people call the reward chemical, so that’s going to be present and dopamine is released in every addictive process by every addictive drug. Serotonin is also released, which makes one less depressed, gives them a feeling of tranquilization and well being. There is even a report that there is an increase in anandamide or endocannabinoids, the marijuana like chemicals in the brain due to chocolate. So chocolate may have some interesting psychoactive properties, including flavonols and how that reacts. But from the overall standpoint, I don’t think chocolate itself is truly addicting as is cocaine or heroin, marijuana, or other drugs. I think chocolate does help mood. It does bring about some good feelings. It does taste good and is useful, especially in dealing with the negative symptoms of menstrual cycles, seasonal affective disorder, and minor depressions. septi People claim chocolate is good for lots of things, but I’m not willing to say that chocolate is a major addictive drug. But tell me about the person eating feathers.
HOWARD: Oh the new “My Strange Addiction” program a new cable show that just debuted recently. One of the first guests was addicted to eating cat fur and apparently had been doing it for something like 15 years.
DARRYL: Oh, it was cat fur, huh? So it’s easy if you have a cat you know how easy that is to collect! You can’t keep it away! Stories like this really solidifies our concept of addiction and the biology of addiction. It is similar to a story we talked about earlier this year that aired on NPR (National Public Radio) about a lady who was obsessed with eating knives and forks.
HOWARD: Oh now, that’s good.
DARRYL: Her Go switch was obviously injured. We know that addicts have a hyperactive go switch or nucleus accumbens septi and that is in the unconscious, non feeling and instinctive area, survival area of the brain. It’s in the most primitive part of our mammalian brain and it is overactive in addicts. It’s not about feeling good or getting off or getting pleasure or any benefit from taking a drug or doing something it is just “they’ve got to do it”
HOWARD: Can’t stop.
DARRYL: Can’t stop. And once activated, it becomes an obsession. In the case of the lady eating cutlery she had such an obsession with eating knives and forks, that she felt if she did not eat them, she would perish, she would die. And every time she ate them, they would have to rush her to the emergency room because the knives were slicing holes through her esophagus and her stomach. So, she wound up in straight jackets for 8 years because they couldn’t control it until they finally found some medications to control her obsession.
HOWARD: That’s truly strange.
DARRYL: Well, it’s not any stranger than somebody who has an obsession to eating cat fur.
HOWARD: Well, it’s right up there!
DARRYL: It is hard to imagine what they are getting out of it but there is that drive and a survival need to do it. This underscores and helps us explain to addicts that addiction is not something they want it’s not necessarily about getting high about or getting pleasure. It’s about an obsession caused by a part of their brain that is hyperactive. It might be cocaine, alcohol, marijuana, Vicodin. It might be methamphetamine. It might be heroin, but it’s an obsession caused by hyperactivity and sensitivity to a particular substance. A strange interaction with their nucleus accumbens occurred and they can’t stop eating cat fur or knives and forks, or feces or any other unusual thing. It’s just a biological function and if a person can accept that, then possibly they can open up and accept that treatment is important in order to live a more normal life. But if they don’t imagine what that lady what would have happened to her if she kept eating knives and forks and nobody intervened. Even the lady with cat fur, I mean, can you imagine the fur balls?
HOWARD: Well, no!
DARRYL: It would be horrible! I think that is amazing to bring up and to talk about and I do think it reinforces our view on addiction. One other thing I wanted to mention about Valentine’s Day and chocolate addiction is that it brought into focus a new addiction. This is almost like a runaway train right now, anyone with an obsession for anything, if it’s defined as such by some therapist, becomes the newest form of addiction. So now we have something called “love addiction”. Some people have decreed that a person obsessed with love and Valentine’s Day…exhibits a pathology rather than a true natural healthy love relationship. These people are constantly craving and searching for romantic relationships, using romantic intensity in order to tolerate their lives, they give up important interests, beliefs, friendships, or other things to maximize their relationship to please a romantic partner. They usually have histories of short failed relationships as they seek out one love relationship after another love relationship because they can’t get enough. There are a list of symptoms.
HOWARD: Well, that’s a good way to end the Valentine’s show, I guess, with an obsession with love. But I think talking about strange obsessions, addictions does paint a bigger picture and makes addiction easier to understand and appreciate, especially for those people grappling with addictions. It is not just them and it is not just their particular drug, but it’s a bigger deal. It’s a larger issue. Anyway, we’re out of time for today thanks for listening and your comments, questions, and suggestions are always welcome. Stop by the website, cnsproductions.com, and leaving a note there. Darryl, thank you and happy chocolate!
DARRYL: Hey, Happy Valentine’s Day, Howard.
HOWARD: That wraps our pod for today. Please check back soon for the next in the series and visit our website, www.cnsproductions.com