Hallucinogen Persisting Perception Disorder
Hallucinogen persisting perception disorder can be a rare, long-lasting neurological consequence of hallucinogen abuse. It typically occurs with LSD, but may also occur following use of other hallucinogens like MDMA , psilocybin, and mescaline.12
HPPD is characterized by flashbacks and chronic or recurrent perceptual symptoms that can make it feel like you are re-experiencing the feelings or sensations you experienced when you used the drug. The key symptom tends to be visual hallucinations , which may cause significant distress and affect your ability to function.13
Which Drugs Kill Brain Cells
Different drugs can have neurotoxic and destructive effects on brain cells. Substances that are associated with neurological damage include but are not limited to alcohol, heroin, amphetamines, marijuana, opioids, inhalants, and cocaine.1,2,5
Drugs can damage brain cells through several mechanisms. Psychostimulants and alcohol disrupt the integrity of the blood-brain barrier , which can change the functioning of your brain cells due to increased permeability . Increased permeability means that toxins can more easily cross the BBB.7
Other substances, including alcohol and inhalants, can cause injury to brain cells due to the way they damage the protective sheaths, known as myelin, that surround nerve fibers. This can cause damage like that which occurs in neurological diseases like multiple sclerosis . This type of damage can affect your thinking, movement, vision, and hearing. The neurological symptoms people experience in this case can range from mild to severe.8,9
What Part Of The Brain Is Responsible For Addiction
There are several parts of the brain involved in addiction. They are:
the nucleus accumbens, a cluster of cells below the cortex in the basal forebrain that produces the urge to pursue a goal. Sometimes called the pleasure center of the brain, it is a key player in the reward circuitry of the brain and releases dopamine in response to positive experiences and the anticipation of such experiences.
dopamine neurons, which are concentrated in the nucleus accumbent and form pathways of connection to other parts of the brain when activated by positive experiences.
the prefrontal cortex, which is the seat of such executive functions as judgment, decision-making, impulse control it gradually weakens in response to overactivation of the reward circuits by drugs of abuse.
the amygdala, which registers emotional significance of perceptions, is highly responsive to drug-related cues and sets in motion the rise and fall of craving.
the hippocampus, seat of memory under the influence of dopamine, the memory of an expected reward results in overactivation of the reward and motivation circuits and decreased activity in the cognitive control centers of the prefrontal cortex.
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How Addiction Affects The Brain
From your temperature to your breathing, your brain controls your body. The brain processes stimulation and develops a response. Because of this, you laugh when something is funny or cry when something is sad. You become dependent on drugs when your brain absorbs this stimulation. Substance use disorders are progressive diseases that worsen without addiction treatment. Mental health counselors can help addicts through withdrawal and prevent future relapses by understanding how addiction affects the brain.
How Can Addiction Affect The Brain But Not Be A Brain Disease
Addiction corrupts the ability to make choices. Addiction brings about changes in the brain, but those changes do not reflect a pathological process. The pathways to addiction can be difficult to understand, because substance abuse, as a result of the intense burst of pleasure it brings, rapidly rewires the circuitry of the brain to become highly efficient at drug wanting and seeking.
At first glance, the fact that addiction shifts the way the brain works lends credibility to the idea of a disease. However, the brain alterations reflect the normal capacity of the brain to change in response to experience. That capacity is called neuroplasticity, and it is the basis of all learning and change. Unlike other organs, the brain is designed to change.
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Are Changes In The Brain From Drug Use Reversible
Certain brain changes can be persistent or permanent, but this can vary widely depending on the type of injury and the substance of abuse. Many substance-related neurological complications or consequences may also be reversible.
WKS, for instance, may present with more chronic and debilitating effects, but when caught early and with proper treatment, WKS might be reversible in certain cases. Research has shown that even people who have suffered from a stroke can make some degree of recovery. Studies have also shown that brain shrinkage and reduced white matter volume associated with alcohol abuse may be reversible.24,25,26,27
NIDA explains that some of the neurological damage to the dopaminergic system appear, at least partly, to be reversible, with many neurological markers for nerve damage returning to normal after several months of abstinence.28 The National Institute on Alcohol Abuse points out that although it can take time, most people suffering from alcohol addiction will experience at least some improvement in brain structure and functioning with abstinence.3
Why Cant They Just Stop Using
Just like we turn down the volume on a radio that is too loud, the brain adjusts to drugs by turning down its ability to receive signals. As a result, the brains reward circuit of a person struggling with addiction is abnormally low. They feel flat, lifeless and depressed. They are unable to enjoy things they used to. They need to keep taking drugs so they feel normal which only makes the problem worse. Because the brain is learning to tolerate the drugs, the person will take larger amounts to produce the same result.
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Does Addiction Permanently Change The Brain
The neuroplasticity of the brain, its ability to shape and reshape itself in response to the environment, is what enables human beings to survive and thrive under the many dynamic circumstances of real life. It is also what underlies addiction. And recovery, like addiction, relies on neuroplasticity as well. The proof that addiction can be unlearned neurally and behaviorally, experts say, is that most addicts recover, eventually.
The brain adjusts its wiring in response to new inputs, new patterns of thinking, feeling, and behaving. Studies show that once drug use stops, and once people explore new interests or resume interrupted ones, there is a gradual restoration of thickness to key areas of the cortex and renewal of circuitry paving pathways for responding to other sources of reward and pleasure. The capacity to respond to drug cues doesnt necessarily vanish entirely, but it is deactivated it is overridden, no longer the only goal capable of firing up the brain, and it diminishes in importance.
Box 1 Whats In A Name Differentiating Hazardous Use Substance Use Disorder And Addiction
Although our principal focus is on the brain disease model of addiction, the definition of addiction itself is a source of ambiguity. Here, we provide a perspective on the major forms of terminology in the field.
Hazardous Substance Use
Hazardous substance use refers to quantitative levels of consumption that increase an individuals risk for adverse health consequences. In practice, this pertains to alcohol use . Clinically, alcohol consumption that exceeds guidelines for moderate drinking has been used to prompt brief interventions or referral for specialist care . More recently, a reduction in these quantitative levels has been validated as treatment endpoints .
Substance Use Disorder
SUD refers to the DSM-5 diagnosis category that encompasses significant impairment or distress resulting from specific categories of psychoactive drug use. The diagnosis of SUD is operationalized as 2 or more of 11 symptoms over the past year. As a result, the diagnosis is heterogenous, with more than 1100 symptom permutations possible. The diagnosis in DSM-5 is the result of combining two diagnoses from the DSM-IV, abuse and dependence, which proved to be less valid than a single dimensional approach . Critically, SUD includes three levels of severity: mild , moderate , and severe . The International Classification of Diseases system retains two diagnoses, harmful use and substance dependence .
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What Parts Of The Brain Are Affected By Drug Use
Drugs can alter important brain areas that are necessary for life-sustaining functions and can drive the compulsive drug use that marks addiction. Brain areas affected by drug use include:
Some drugs like opioids also disrupt other parts of the brain, such as the brain stem, which controls basic functions critical to life, including heart rate, breathing, and sleeping. This interference explains why overdoses can cause depressed breathing and death.
How Does Addiction Work In The Brain
Repeated use of a drug changes the wiring of the brain in a number of ways. It stimulates the nucleus accumbens, and overactivity of the nucleus accumbens progressively weakens its connectivity to the prefrontal cortex, seat of executive functioning. One result is impaired judgment, decision-making, and impulse control, a hallmark of addiction.
Neuroscience research supports the idea that addiction is a habit that becomes quickly and deeply entrenched and self-perpetuating, rapidly rewiring the circuitry of the brain because it is aided and abetted by the power of dopamine. Under the unrestrained influence of dopamine, the brain becomes highly efficient in wanting the drug it focuses attention on anything drug-related and prunes away nerve connections that respond to other inputs. The biological weakening of decision-making areas in the brain suggests why addicts pursue and consume drugs even in the face of negative consequences or the knowledge of positive outcomes that might come from quitting the drugs.
Retraining The Brain After Addiction
Even if people understand the changes and cycle of addiction and how it changes the brain, they cannot stop on their own. The brain is dependent on drugs or alcohol, so a person needs to commit to recovery to change his or her lifestyle. When in treatment, a persons brain needs to be re-trained to function normally, without toxic substances. It will take time for the brain to re-adjust to a sober, healthy lifestyle.
At Corner Canyon Health Centers, we focus on the Gut-Brain connection to restore adequate levels of serotonin and dopamine in the brain. Its our top priority to heal the brain after someone has suffered from addiction.
New Insights Into A Common Problem
Nobody starts out intending to develop an addiction, but many people get caught in its snare. Consider the latest government statistics:
- Nearly 23 million Americansalmost one in 10are addicted to alcohol or other drugs.
- More than two-thirds of people with addiction abuse alcohol.
- The top three drugs causing addiction are marijuana, opioid pain relievers, and cocaine.
In the 1930s, when researchers first began to investigate what caused addictive behavior, they believed that people who developed addictions were somehow morally flawed or lacking in willpower. Overcoming addiction, they thought, involved punishing miscreants or, alternately, encouraging them to muster the will to break a habit.
The scientific consensus has changed since then. Today we recognize addiction as a chronic disease that changes both brain structure and function. Just as cardiovascular disease damages the heart and diabetes impairs the pancreas, addiction hijacks the brain. This happens as the brain goes through a series of changes, beginning with recognition of pleasure and ending with a drive toward compulsive behavior.
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Driven By Compulsion Or Free To Choose
A major criticism of the brain disease view of addiction, and one that is related to the issue of determinism vs indeterminism, centers around the term compulsivity and the different meanings it is given. Prominent addiction theories state that addiction is characterized by a transition from controlled to compulsive drug seeking and taking , but allocate somewhat different meanings to compulsivity. By some accounts, compulsive substance use is habitual and insensitive to its outcomes . Others refer to compulsive use as a result of increasing incentive value of drug associated cues , while others view it as driven by a recruitment of systems that encode negative affective states .
What Drugs Release Dopamine In The Brain
All addictive drugs trigger the release of dopamine.6 In past years, it was believed that dopamine was directly responsible for the intense euphoric high that a drug produced, but experts now believe that dopamine plays a more complicated role.4
Dopamine surges signal to the brain that an activity should be remembered and makes it easier for it to be repeated. For example, if a person enjoys a nice meal, a little surge of dopamine occurs to help the brain remember to eat that meal again. This role dopamine plays in repetition of behavior helps us create habits.4
Drugs produce much larger bursts of dopamine than a natural reward like a meal would, however, so they create a verystrong connection between taking the drug, the pleasure that comes afterward, and all of the cues around the person that are linked to their drug consumption . As these connections are created and strengthened, the brain begins learning to prioritize getting and taking drugs over seeking out natural, healthy rewards.4
Because dopamine helps to create such powerful connections in the brain, the external cues associated with drug use can trigger overwhelming drug cravings years after a person has gotten clean.4 This is one of the reasons that recovery is a lifetime pursuit and that relapse is so common.
Other Parts Of The Brain
Aside from the three major parts of the limbic system, there are also related brain areas that can dysfunction with long-term drug use.
- Cingulate gyrus: This part serves as a pathway between the hypothalamus and the hippocampus. A drug-impaired cingulate gyrus may have strong associations between many stimuli and triggers to substance use.
- Ventral tegmental area: These are also called dopamine pathways. People who abuse drugs and alcohol often have damage in this area because they cannot easily find pleasure through natural means. However, the continuous use of substances further adds to the problem of tolerance and dependence.
- Basal ganglia: This area of the brain is known to control reward-seeking behavior. The basal ganglia becomes impaired when the only association of getting a reward is through the abuse of substances.
- Prefrontal cortex: The prefrontal cortex is responsible for thoughtful decision-making and calculation of risks. For people with addictions, the prefrontal cortex functions differently, as decision-making turns more into an emotional rather than a logical response.
When looking at the big picture, we can view the addictive substance as an unwelcome guest in an otherwise perfectly performing harmonic orchestra. As the drug or alcohol sends out abnormally high levels of feel-good chemicals or mimics them in some way, these other brain areas which control the rest of the body get disrupted as well.
Why Is Addiction Considered A Brain Disease
The brains of people with addiction are different from those who dont have it. This is something we have known since the 1980s, and further research has only solidified this.
Both the American Medical Association and the World Health Organization consider addiction to be a illness.
Addiction has characteristics that are consistent with other diseases, such as:
- It is a primary diagnosis that causes other medical issues
- Addiction is a progressive disease, meaning it gets worse over time.
- Addiction is chronic. There is no cure for addiction and people have it for life.
- Childhood trauma can cause changes in the neurological wiring of the brain. Neurological wiring differences impact an individuals ability to cope with stressors, making them more likely to turn to drugs and alcohol.
Once the brain disease model of addiction emerged, therapies were modified to treat the brain, rather than treating addiction as a lack of willpower.
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How The Brain Responds To Withdrawal
During abstinence and withdrawal, these neurotransmitters are decreased resulting in feeling pain, anxiety, and dysphoria, Dr. Fiellin says. It is these changes, as well as other neurocircuitry, that occur in the brain that may drive the person to seek out the substance just to feel normal.
When the intoxicating effects of a substance wears off, there is an increase in signaling in some circuits of the forebrain. This firing triggers cravings for the substance and drives the individual to seek the substance out.
Whats wild, is that search alone can release dopamine into the basal ganglia when someone is craving the substance. This motivates them to keep going until they find it and consume the substance.
In brains that are not addicted, these circuits in charge of desire are held in check. The prefrontal cortex, which helps us make rational decisions and regulate emotions, prevail because the individual can balance the long-term goals against immediate reward.
But, repeated substance exposure can weaken these circuits. And in that case, the desire for the substance is too strong to ignore. This is what makes it so difficult for the individual who is living with addiction to stop taking the substance despite negative experiences with the substance, or even, lack of the pleasure they once experienced.
What Role Does The Brain Play In Addiction
The brain plays a leading role in addiction, just as it plays a role in all human behavior. The choice to try a drug is a decision that that is centered in the executive portion of the brain, the prefrontal cortex. Once consumed, the drug delivers a powerful stimulus to the nucleus accumbens, a cluster of nerve cells below the cerebral cortex, which responds quickly by releasing a flood of dopamine. The neurotransmitter dopamine is often called the pleasure molecule, but it is more correctly defined as a chemical that underlies motivation. It focuses attention on and drives people to pursue specific goals.
The sensation of pleasure orchestrated by dopamine likely arose to encourage repetition of behaviors that support individual and species survivaleating, interacting with others, having sex. The high level of direct stimulation by drugs of abuse powerfully encourages repetition. Addiction can be seen as hacking the brain by drugsa way to create a direct path to feeling good.
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