Category Archives: Addiction Courses

Neural circuits of preoccupation/ anticipation “craving” stage

September 19, 2014

Addiction and It Stages

Drug addiction is a slow developing disorder that is long lasting characterized mainly by the urge to seek and take the drug, loss of control in limiting intake and development of a negative emotional state of anxiety and irritability. When the drug is prevented, the user exhibits withdrawal symptoms. Drug addiction has been viewed as a condition that involves element of both impulsive and compulsive behavior that is brought about by the addiction circle. The circle is made up of three stages: the intoxication stage the negative or the withdrawal effect, and the anticipation stage/ preoccupation which is the craving stage.

The neural circuits of the brain affected

Study on human behavior has revealed discrete circuits that play a major role in binding a major stage of the addiction circle. The ventral tegmental area and ventral striatum is the main focal point for the intoxication stage. The extended amygdala plays the role in the withdrawal while the  orbitofrontal cortex–dorsal striatum, prefrontal cortex, basolateral amygdala, hippocampus, and insula are involved in craving and the cingulate gyrus, dorsolateral prefrontal, and inferior frontal cortices in disrupted inhibitory control which is the preoccupation/anticipation stage. Drug addiction therefore alters the normal functioning of the neural circuits which may begin with changes in the mesolimbic doper mine system and the process of neural adaptations from the ventral striatum to dorsal striatum of the frontal cortex and eventually deregulates the prefrontal cortex and extended amygdala.

neural circuits

Of late there have been studies aimed at understanding the genetic cellular and molecular mechanisms that mediate the transitions from once-in-a-while drug use to the loss of a person’s control of a drug abuse and to the final stage of a relapse even after trying to abstain. Drug addiction has aspects of both impulsivity and compulsivity disorders. Impulse control disorder is precisely an increased sense of tension before engaging in an impulsive act and a feeling relieved at the time of committing the act. They are categorized as the positive and strengthening mechanisms. On the other hand compulsive disorders are characterized by anxiety and stress before taking part in a compulsive redundant behavior and relieve from the stress by carrying out the compulsive behavior. The compulsive disorders are greatly associated with negative reinforcement’s mechanisms.

Impulsivity and compulsivity.

As the stage of addiction moves from one cycle to the other, the user moves from a stage of impulsivity to a stage of impulsivity and compulsivity. As a result, they are no longer positively reinforced by the drug but negatively influenced. These three stages of addiction are attributed to interacting with each other getting more intense and finally leading to the pathological stage called addiction.  The brain neural circuitry system is engaged at each stage of the addiction cycle and changes with increased intake of the drugs of abuse hence producing the disorder known as addiction. Since the brain responds to stimulus the entire system becomes oriented specifically toward drug related stimuli leading to an increased drive for seeking and taking drugs.

Executive dysfunction

Executive dysfunction is a range of cognitive, emotional and behavioral difficulties which occur after the frontal lobe of the brain is injured. The executive function include abilities such as: planning and organization, social behavior, controlling emotions, safe awareness among others. Drug abuse alters the normal functioning of the frontal lobe of the brain and leads to executive dysfunction. This leads to deficits in cognitive skills which involves thinking, personality and social behavior. Executive dysfunction also makes it difficult to solve problems and as a result drug addicts do not make accurate judgments or find solutions if things are going wrong. They are also irritable find it hard to concentrate lose their r memory and do not get enough sleep. It is very hard for people with this this problem to get along with others as they appear antisocial and can be misunderstood as depression lack of motivation, selfishness and aggression.

Future treatment targets.

neural circuitsGABA receptor substance that does not act as agonist or antagonist but affects the gamma-amino butyric acid receptor-ionophore complex. The GABA receptors play a role in almost every single activity of the brain. Ultimately glutamate and GABA do the information processing; they’re the ones that encode sensory inputs and thoughts (GABA directly modulates the effect of glutamate). There is the cognitive enhancement which requires the knowledge of cognition and what it involves. This cognitive enhancement could be aimed at improving short-term memory, improving information processing improving recall, or enhancing long-term potentiation. Each of this involves different circuits that involve multiple neurotransmitter systems.

Homeostatic resetters refers to the process of removal of toxic substances from the body of an individual through a process called detoxification in that at the end of the process the body returns to homeostasis after a long term use of an addictive substance.

CRF is brain stress systems that is engaged during the withdrawal/negative affect stage. This will reduce the dopamine activity and also help in restoring the frontal lobe of the brain. Therefore, the CRF increases in the effects that occur with sudden withdrawal from drugs and have motivational significance not only for the anxiety effects of acute withdrawal but also for the increased drug intake associated with dependence.

Glutamate modulators are used to reduce the habits of addiction by greatly improving the mood of the user and treating major depressive disorder. Glutamate is the most abundant excitatory neurotransmitter in the brain. There has been studies carried out which have shown altered glutamate levels in serum and cerebrospinal fluid from patients with mood disorders. Administering glutamate to this patients will therefore greatly improve their mood.

Neural Circuits Of Preoccupation/ Anticipation “Craving” Stage

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Marijuana Smoker’s Processing Emotional Information In The Amygdala

September 19, 2014

Marijuana Smokers Process Emotional Information Differently In The Amygdala

Marijuana refers to the dried leaves, flowers, stems and seeds from the hemp plant Cannabis sativa. It contains the psychoactive which results in mind-altering chemical called the delta-9-tetrahydrocannabinol (THC), and other compounds related to it. Marijuana is the most common illicit drug used all over the world especially in the United States. Its use had declined for close to a decade and then became very common as from 2007 as the effects associated with it are becoming more diminished. Marijuana is usually smoked in hand-rolled cigarettes called joints or smoked in blunts-cigars that have been emptied off tobacco. The smoke has a pungent smell usually sweet-and-sour, odor. It can also be mixed in foods and drinks.

When marijuana is smoked the THC is rapidly passed from the lungs into the bloodstream, which carries the substance to the brain. When it is ingested in foods and drinks, this process is much slower. According to the Institute of Medicine published in Mar 1999 report titled “Marijuana and Medicine: assessing the Science Base”: the THC enters the brain, it causes the user to feel euphoric (high) by acting on the brain’s reward system which consists of regions that are responsible for governing pleasurable things like sex and chocolate as well as to most drugs of abuse. THC activates this receptors of the brain by simulating brain cells to release the chemical dopamine.

Marijuana

The users describe two stages of feeling high after intake of marijuana: initial simulation (giddiness and euphoria), followed by sedation and a pleasant tranquility. Their also reported altered perceptions of time and distance as well as heightened sensitivity to sights and sounds. Relaxation is also another frequently reported effect in users of marijuana. They tend to become more relaxed and there is a feeling of bliss and contentment. Their appetite is also greatly improved. After a while, this effects subsidized and the user may feel sleepy or depressed. On rare occasions, marijuana use may produce anxiety, fear, distrust or panic. Users may get very paranoid and anxious until the euphoria reduces.

Marijuana also affects brain development, and when it is used heavily by young people, its effects on their memory and thinking capacity may last a long time or even be permanent.  According to a recent study of marijuana users, those who started using at a very young age showed greatly reduced connectivity among brain areas responsible for learning and memory. Those who started smoking heavily in their teens have lost an average of 8 points in IQ between the age 13 and 38, according to a study in New Zealand. Those who started smoking marijuana in their adulthood did not show fairly large declines in their IQ. Marijuana also impairs a person’s ability to form new memories and to shift focus. The substance THC disrupts a person’s coordination and balance by binding to the receptors in the cerebellum and basal ganglia responsible for regulating balance, posture, coordination, and reaction time.

Large intakes of marijuana makes users have acute psychosis, which is basically hallucinations, delusions, and a loss of the sense of identity. Marijuana users are very much likely to end up depressed, anxious and generally their loose the will to live and become suicidal as well as personality disturbances. One of the controversies on the same is the amotivational syndrome, defined as a diminished or absence of the drive to take part in any rewarding activity. As a result of the endocannabinoid system regulating mood, these associations make a certain amount of sense; however, this research is yet to be completed to help us better understand how marijuana use is connected to mental illness in the future. This research also shows that, individuals with one or two copies of the Val variant have a higher risk of developing schizophrenic-type disorders if they used marijuana during adolescence.

Marijuana use during pregnancy is associated with increased neurobehavioral problems in baby after birth. The baby’s endocannabinoid chemicals are mimicked by the marijuana THC and other compounds. This in result causes poor development of the endocannabinoid system in the brain of the fetus. This will in future result in poor memory, problems in attention and problem solving hence they become very slow in responding to their surrounding stimuli. THC exposure also disrupts synapses which help connect nerve cells and allow for the efficient transfer of neurotransmitters. The child is also likely to develop more psychiatric illnesses such as depression, anxiety, attention-deficit disorder, and schizophrenia.

Marijuana

Marijuana use for a long time causes the brain to continually make the user crave for the same as one tends to get addicted. The development of the frontal cortex is affected and as a result affect a person’s reward system leading to prolonged addiction, and ultimately affects one’s decision making. This addicts are more likely to get impaired executive function and a proclivity to choose the easier task. This may be seen in the user taking part in criminal activities and engaging in violence.

Research has shown that heavy marijuana users tend to have more problems in their daily life or it makes their existing problems worse. They report lower life satisfaction, poorer mental and physical health, more relationship problems, and they also have less academic and career success compared to non-marijuana users. They tend to drop out of school more, they are the highest number of the absentees in their places of work and also are likely to get into accidents more. They have poor coordination. Marijuana users who have become addicted should seek help in rehabilitation centers. As of late, more research is being carried out to determine more effects of marijuana in the brain. It has also been introduced in the medical field as it is given to cancer patients to increase their appetite and to reduce pain.

Marijuana smokers process emotional information differently in the amygdala

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Using Naltrexone To Treat Addiction Relapse

September 19, 2014

Using Naltrexone To Decrease Alcohol Relapse

Annually, around 1.5 million people in the USA seek treatment for alcohol and its related problems. In 1994, naltrexone became approved for the treatment of alcoholism by the U.S. FDA. Naltrexone works by blocking opioid receptors found in the brain as well as stemming the endorphin-mediated reinforcing effects of drinking alcohol. There is great  evidence to suggest and prove  that naltrexone has power to significantly reduce alcohol relapses to heavy drinking, the frequency of drinking, quantity of alcohol consumed  by  those who do drink, and also alcohol craving. Naltrexone is vitally beneficial in helping those patients who cannot abstain so as to reduce their drinking patterns, breaking the vicious self-destructive cycle of alcoholics which causes one to drink one drink which leads to the other together with allowing more quality time for psychosocial therapy to be productive. Naltrexone has demonstrated efficiency in a various alcohol-treatment settings using adjunctive psychosocial therapies that provide patients with motivation to stay in treatment, overcome relapses, and also take medications. Individualized and flexible naltrexone dosing can be of great benefit. Longer-term naltrexone therapy exceeding more than three months may be most effective, and naltrexone might be used on an as-needed, “targeted,” basis indefinitely. Alcohol is a very complex substance that affects several chemical systems in the brain.  It is presumed that, when an alcoholic drinks, the brain’s opioid system releases endorphins that trigger the reinforcement that is responsible for enticing one to drink more. Unlike other drugs that were earlier used to treat alcoholism, naltrexone is not addictive in nature and composition and does not in any way react aversively with alcohol.

Natraxene

·        Monthly naltrexone injection to control alcoholism

A monthly dose of Naltrexone, under different trade names, is already in use to treat alcoholism. The monthly dose is   a more convenient approach than current daily oral doses. Using naltrexone combined with counseling could help reduce heavy drinking in people suffering from alcoholism. Because of problems with adhering to daily oral doses of naltrexone, the effectiveness found in treating alcohol dependence with a once-a-month injection of naltrexone improves long-term treatment results. According to a previous study in 2005, naltrexone showed efficiency for treatment of alcohol dependence. However, adherence to daily oral doses can be hectic, and therefore, utilization of oral naltrexone have been limited.

·         Naltrexone should be used with caution in patients with liver disease

For a person suffering from hepatitis or liver failure, naltrexone should not be prescribed.it is recommended that liver function tests such as ALT, AST, gamma glutamyltransferase and bilirubin must be conducted before naltrexone treatment begins and at intervals after the treatment begins. In healthy patients without liver disease, intervals of 1, 3, and 6 month scan be ideal for the tests, then yearly thereafter. Liver function tests should be performed more frequently especially if baseline liver function test results are high, a history of hepatic disease is confirmed, or if a potential hepatotoxic medication is prescribed and if the patient is taking doses higher than 50 mg/day. Naltrexone should be used cautiously in patients whose serum aminotransferase results are greater than five times the upper limit of normal. 

  • Cannot be used for people using opioid for pain management

A careful drug use history and urine toxicological screening should also be done so as to confirm abstinence from opioids, including prescribed pain medications, as well as a lack of opioid dependence before initiating treatment. Comprehensive urine tests should be carried out to measure methadone and other opioids. However, urine testing can be subject to error because typical urine screening tests may not cover all opioids and samples can be tampered with to affect the results.

It is important to note that Administration of naltrexone should not be initiated until the patient has been opioid-free for between 7 to 10 days and that the naloxone challenge test for opioid withdrawal is negative. If no abstinence signs are observed following a preliminary dose of naltrexone 25mg, the rest of the daily dose is administered. Maintenance treatment regimen with naltrexone can be flexible where patients may receive naltrexone 50mg on weekdays and 100mg on Saturday or 100mg every other day, or 150mg every third day. Naltrexone is not suitable for use in patients with acute hepatitis or liver failure and should not be used in patients receiving opioid analgesics. The major active effect of naltrexone is on opioid drugs, which is one class of drugs used primarily to treat pain but is also found in some prescription cough preparations. This is because Naltrexone will block the effect of normal doses of this type of drug. There are many non-narcotic pain relievers that can be used effectively while you are undergoing treatment with naltrexone. Anyway, naltrexone is likely to have little impact on other medications patients commonly used in patients such as non-opioid analgesics (e.g., aspirin, acetaminophen, and ibuprofen) and antibiotics, and allergy medications.one should inform a physician of whatever medication he or she is currently taking so that possible interactions can be examined. Since naltrexone is metabolized by the liver, treatments that affect liver function may influence the dose of naltrexone.

naltrexone

A point to note is that naltrexone neither reduces the effects of alcohol that impair coordination nor judgment. Also Naltrexone’s effects on blocking opioids occurs shortly after the first dose is administered. Furthermore, findings confirm that the effects of naltrexone in helping patients remain abstinent and avoid relapse to alcohol use also occur early. However, Naltrexone should not be used with expectant women, people with liver or kidney damage or with patients who cannot practice abstinence for at least 5 days prior to commencing treatment. Also, people who are dependent on opioids such as heroin or morphine must cease their drug use at least 7 days prior to starting naltrexone.

Other than side effects, which are usually for a short period as well as mild, patients normally report that they are unaware of feelings of being on this medication. Naltrexone usually has no psychological effects and patients do not feel funny. It is also not addictive. While it reduces alcohol craving, it does not interfere with the experience of other types of pleasure.

Using Naltrexone To Decrease Alcohol Relapse

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Marijuana withdrawal Definitive Symptoms

September 18, 2014

Marijuana withdrawal Definitive Symptoms Cannabis withdrawal involves at least two psychological and one physiological symptom

Marijuana withdrawal

MarijuanaCannabis withdrawal involves the experiencing of at least two psychological and one physiological symptom after ceasing heavy and prolonged use of marijuana. Some psychological symptoms are being Irritable, Anxiety, Depressed mood, being Restless, insomnia, reduced appetite and weight loss. Physical symptoms include abdominal pain, shaking, fever and headaches. These withdrawal symptoms cause a person to be distressed and interference with school, work, or any other daily responsibilities. Many cannabis users agree that withdrawal symptoms make it difficult for them to quit or have contributed to relapse. Most symptoms normally begin within the first 24–72 hours of cessation, peaking within the first week, and lasting approximately 1–2 weeks. Sleep difficulties may last more than 30 days. However, Withdrawal tends to be more common and severe among adults, mostly because of the more persistent and greater frequency and quantity of use among adults.

Marijuana screening

A lawful and effective detection for cannabis can take lots of time, and tests cannot define an exact degree of impairment. Nevertheless, The focusses obtained from such analyses be helpful in differentiating between active use from passive publicity, time since use, and the degree or period of use. The Duquenois-Levine test is normally used as a screening test in the field, but it cannot confirm the existence of cannabis, as a large variety of substances have been shown to provide false positives. The Duquenois–Levine test is a modest chemical color reaction test originally established in the 1930s by Pierre Duquénois. these tests involve a police officer  breaking  the seal of a tiny micropipette of chemicals, and placing an element of the assumed substance; should the chemicals turn purple, this shows the prospect of marijuana. The color variations can however be subtle, and readings can also vary by the surveyor.

  • Cows Score Withdrawal(Clinical Opiate Withdrawal Scale)

Marijuana intake before and during treatment decreased the patients score on the Clinical Opiate Withdrawal Scale (COWS) According to the Thomas Jefferson University study  .This measure is used to accurately define withdrawal symptoms in opiate-dependent patients. The lesser scores specify that cannabis plays a part in decreasing the symptoms of opiate withdrawal.

  • DSM-V Criteria And Its Relevance In Marijuana Dependency

(DSM-V) also known as Diagnostic and Statistical Manual of Mental Disorders is used to eradicate the disease kinds for substance abuse and dependence and swaps it with a new “addictions and related disorders”

Eradicating the kind of dependence helps in better distinguishing between the compulsive drug-seeking behavior of addiction and ordinary responses of tolerance and withdrawal that some patients experience when using prescribed treatments that affect the central nervous system, Also new to the DSM-V are diagnostic criteria for “cannabis withdrawal,”. Outcomes in “clinically important distress or impairment in social or any other essential areas of working,” and is characterized by at least three of these symptoms:  anger, aggression, irritability, anxiety or nervousness; insomnia, decreased appetite or weight loss; restlessness, sweating, fever, chills, and headache.

Screening

  • Quantity and frequency of joints per day

There is no known comparable portion of cannabis consumption, possibly due to encounters such as varied joint size, tetra hydro cannabinol content, and ways of delivery Cannabis-related problems, measured by smoking, the alcohol and Substance Connection Screening Test, were foreseen from cannabis use frequency and quantity controlling for gender and age. This sample included 665 participants between the age of 15-67. Cannabis use occurrence and quantity were clearly linked with cannabis-related difficulties. People who smoked cannabis daily were at the highest risk of problems. Controlling for occurrence, the effect of quantity remained important for disappointment to do what is expected due to cannabis use. Research advises that quantity, above and beyond frequency, is a vital predictor of cannabis problems

  • Urine THC can last weeks after stopping

cannabisCannabis use can often be detected up to 5 days after exposure for people who don’t use it often but up to 15 days for people who use it heavily. People with high body fat can last up to 30 days[, an occasional or on-off user would be very unlikely to test positive beyond 3–4 days since the last use and a chronic user would be unlikely to test positive much beyond 7 days. The maximum likely times are 7 days and 21 days, in that order. In extraordinary circumstances of extended marijuana use, detection times of more than 30 days are possible in some individuals. Nevertheless, one needs to remember that every person is different, and exposure times can vary due to other factors. Cases]Common known pharmaceutical drugs which cause false positives in instant THC dip tests include:  Ibuprofen, Dronabinol, ketoprofen e.t.c

  • “Spice” can be wide variety of substance

The word ”Spice” refers to a extensive variety of herbal mixtures that produce know-hows comparable to marijuana (cannabis) and that are labelled as “safe,” legal alternatives to that drug. Usually dispensed or sold under several names, including K2, fake weed, Yucatan Fire, Skunk, Moon Rocks, among others — and also usually labeled “not fit for human consumption” — these products usually comprise of some dried, shredded plant material and chemical spices that are accountable and responsible for their psychoactive (mind-altering) Labels on Spice products often claim that they contain “natural” psycho-active material taken from a variety of plants. Spice products do contain dried plant material, but chemical analyses show that their active ingredients are synthetic (or designer) cannabinoid compounds. Another selling point is that the chemicals used in Spice are not easily detected in standard drug tests.

Marijuana withdrawal Definitive Symptoms Cannabis withdrawal involves at least two psychological and one physiological symptom

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THC on Neurodevelopment of Fetuses

September 17, 2014

Long Term of THC on Neurodevelopment of Fetuses

The most vulnerable state in a woman’s life is during pregnancy. This is because at this time she not only has one life to take care of but also another young life that is even more vulnerable. This therefore calls for caution. A woman who is pregnant should be wary of what passes through her mouth and proceeds right into her body. This is because whatever she eats can either make her gestation period and life after a healthy affair or a nightmare. More often than note the life behaviors of a pregnant mother impacts on the life of the foetus as well and therefore it is important for a pregnant woman to distance herself from all drugs and other risky life choices that may impact negatively on the life of her offspring. Just as good nutrition and clinical visits are emphasized to pregnant women it is also good to encourage these women to stay away from harmful drugs like cocaine, bhang and even alcohol. Unfortunately pregnant women have not seen the need to quit indulging in these risky behaviors even when they are expectant. If current research findings are to be believed, about 4% of women in the USA use illicit drugs while pregnant. Seventy five percent of these cases report the use of marijuana. Despite the widespread use of this product, the public is not aware of the potential neurobehavioral effects of this drug on the fetus or the newborn infant. Tetrahydrocannabinol (THC) is the most effective compound found in cannabis sativa. Unfortunately it is effective for all the wrong reasons as it affects the neurodevelopment in fetus and newborn infants. Needless to say it has been used in few doses to avoid nausea and vomit in cancer patients. It has also been used to increase appetite in patients but when used for non medical reasons nothing good can come out of this compound.

THC

Effects of cannabis during pregnancy

Recent studies have proved that children who are exposed to marijuana prenatally encounter such problems as social and cognitive disturbances. One of these study suggested exposing children to heavy marijuana use prenatally increased the risk of giving birth to low weight babies and the reduced head circumference in teenagers is a proof to this argument. It is also exposing fetus to heavy marijuana use prenatally increased the risk of childhood leukemia. Exposing fetus to heavy use of marijuana prenatally also resulted in both long term and short term memory loss. Even as the infants grow into youths they become very poor in judgmental skills and mostly become very slow in learning and adopting new ideas.

In another study, 42 postmortem fetal brain samples from pregnant women at mid gestation (between 18 – 22 weeks old) who voluntarily underwent saline induced abortion, a decrease in dopamine receptor (D2) mRNA expression in amygdala with significant prevalence in male fetuses. 7 Extensive marijuana exposure in utero was associated with the lowest reported mRNA levels. However this study did not show whether this change is transient or permanent but still it was able to prove that exposure to heavy use of marijuana resulted in low mRNA levels.

Effects of Cannabis during breast feeding

When a woman continues to use marijuana, the THC compound in it will not quit causing the side effects it is known for to this infant but will still continue to hurt the life of the infant. The compound will not stay in the mother alone but will be passed to the infant when breast feeding since it is secreted in milk. This may cause side effects in the life of the infant as it will be absorbed and retained in the body of the infant. Researchers opine that at the point of intake into the infant the proportions of the dangerous compound in the milk is minimal to cause any clinical problems but it is sufficient enough to cause serious long-term effects in the infant. It may take time but in the end it affects the neurobehavioral functioning of an infant .Infants exposed to marijuana through breast milk will test positive in urine screens for about 2-3 weeks. One study of 16 women indicated decreased plasma levels of prolactin especially in the luteal phase of the menstrual cycle.

thc

THC decreases IQ in children

When you are pregnant but you choose to indulge in using marijuana during your pregnancy be sure to have a child that is not very well upstairs. The exposure of a child to THC prenatally will decrease their Intelligence Quotient. This problem affects the teens as that is the period that they try to accomplish things by themselves. Most of the dangers that THC cause to infants are seen during the teen. They become poor planners which make it rather difficult to keep the pace with their other fellows.

The use of marijuana in pregnant women is a cause for concern everywhere and it is advisable that women should stay away from using marijuana not only for their health but also for the life of their offspring. The effects of marijuana that they absorb in their blood during infancy end up affecting them during their entire lives. THC is a dangerous compound and so women should avoid interacting with it to save their children from long-term neurobehavioral anomalies.

Dr. Dalal Akoury (MD) is an experienced doctor that has helped many cancer patients in their fight against the disease. She is also dedicated to offer help to addiction patients. She founded AWAREmed Health and Wellness Resource Center which is home to many people seeking health breakthrough. Call on her now and learn more on how to fight drug addiction.

Long Term of THC on Neurodevelopment of Fetuses

 

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