11

Understanding Dual Understanding Dual DisordersDisorders

The Brain ChemistryThe Brain Chemistry

of Addiction and Mental Illnessof Addiction and Mental Illness

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The Complex Human BrainThe Complex Human Brain

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44

55

66

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Individual Brain Cell (neuron)Individual Brain Cell (neuron)

88

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Individual Brain Cell (neuron)Individual Brain Cell (neuron)

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Individual Brain Cell (neuron)Individual Brain Cell (neuron)

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From one brain cell to another . . .From one brain cell to another . . .

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NeurotransmittersNeurotransmitters SerotoninSerotonin regulates sleep and body temperature; also regulates sleep and body temperature; also

involved in the regulation of sex, aggression, sleep and involved in the regulation of sex, aggression, sleep and mood;mood;

Dopamine Dopamine is involved with voluntary movement and is involved with voluntary movement and emotional arousal; along with emotional arousal; along with norepinephrinenorepinephrine, is , is known as one of the excitatory neurotransmitters, known as one of the excitatory neurotransmitters, which can have the effect of elevating a person’s which can have the effect of elevating a person’s mood;mood;

EndorphinsEndorphins and and enkephalinsenkephalins (the body’s “internal (the body’s “internal opiates”)opiates”) reduce pain and produce euphoria and a reduce pain and produce euphoria and a soothing effect, as neuronal pathways associated with soothing effect, as neuronal pathways associated with pain pass through the limbic system pain pass through the limbic system (the seat of (the seat of emotion).emotion).

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The “3 Rs” ofThe “3 Rs” ofNeurotransmissionNeurotransmission

RReleaseelease RReceptioneception RRe-uptakee-uptake

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ReleaseRelease

Release of neurotransmitters can be likened Release of neurotransmitters can be likened to the flow of water into a bathroom sink . . .to the flow of water into a bathroom sink . . .

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From one brain cell to another . . .From one brain cell to another . . .

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ReceptionReceptionReception of neurotransmitters across the Reception of neurotransmitters across the synaptic cleft (i.e., the space between synaptic cleft (i.e., the space between nerve cells) can be likened to water going nerve cells) can be likened to water going down the drain . . .down the drain . . .

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From one brain cell to another . . .From one brain cell to another . . .

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Re-uptakeRe-uptake

If water that doesn’t go If water that doesn’t go down the drain were to down the drain were to somehow be sucked somehow be sucked back up into the faucet, back up into the faucet, that is what Re-uptake that is what Re-uptake would be like . . .would be like . . .

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From one brain cell to another From one brain cell to another – and back again . . .– and back again . . .

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Brain Chemistry Brain Chemistry and and Mental IllnessMental Illness

-- Thought disordersThought disorders- Mood disorders- Mood disorders

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Schizophrenia and Brain Schizophrenia and Brain Chemistry – Chemistry – too much Dopamine?too much Dopamine?

DopamineDopamine is the is the neurotransmitter that neurotransmitter that is decreased to a is decreased to a certain degree by all certain degree by all antipsychotic antipsychotic medications, in an medications, in an effort to decrease the effort to decrease the overabundance of dopamine that overabundance of dopamine that is thought to contribute to is thought to contribute to psychotic symptomspsychotic symptoms

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Decreasing NeurotransmissionDecreasing Neurotransmission

Medications can DECREASE the effect of a Medications can DECREASE the effect of a neurotransmitter in two waysneurotransmitter in two ways

Decrease ReleaseDecrease Release

Block ReceptionBlock Reception

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Decreasing DopamineDecreasing Dopamine

Antipsychotic medications seek to Antipsychotic medications seek to DECREASE Dopamine, resulting in less DECREASE Dopamine, resulting in less “water going down the drain”“water going down the drain”

Decrease Release, Decrease Release, oror

Block Block ReceptionReception

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Depression and Brain Chemistry Depression and Brain Chemistry – – not enough Serotonin?not enough Serotonin?

SerotoninSerotonin is the is the neurotransmitter that is neurotransmitter that is increased to a certain increased to a certain degree by many degree by many antidepressant antidepressant medications, in an effort medications, in an effort to counteract the to counteract the shortage that is thought shortage that is thought to contribute to to contribute to depressive symptomsdepressive symptoms

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Increasing NeurotransmissionIncreasing Neurotransmission

Medications can INCREASE the presence Medications can INCREASE the presence of a neurotransmitter in two waysof a neurotransmitter in two ways

Increase ReleaseIncrease Release

Block Re-uptakeBlock Re-uptake

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Increasing SerotoninIncreasing Serotonin

Medications can INCREASE the presence Medications can INCREASE the presence of a neurotransmitter in two waysof a neurotransmitter in two ways

Increase Release, Increase Release, oror

Block Re-uptakeBlock Re-uptake

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SSRI AntidepressantsSSRI Antidepressants

SSRI stands for SSRI stands for SSerotonin erotonin

SSerum erum

RRe-uptake e-uptake

IInhibitornhibitor

This type of medication seeks to increase the This type of medication seeks to increase the action of Serotonin by blocking its Re-uptake, action of Serotonin by blocking its Re-uptake, thus resulting in a greater amount of “water in thus resulting in a greater amount of “water in the sink” that is likely to cause more to “go the sink” that is likely to cause more to “go down the drain” (increased Reception)down the drain” (increased Reception)

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Brain Chemistry Brain Chemistry and and Substance UseSubstance Use

- - “Uppers” “Uppers” (Stimulants) - “Downers” - “Downers” (Depressants) - “All-Arounders” - “All-Arounders” (Psychedelics)

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ReleaseRelease

Drugs that INCREASE the flow are like turning Drugs that INCREASE the flow are like turning open the tap all the way . . .open the tap all the way . . .

Drugs that DECREASE the flow are like Drugs that DECREASE the flow are like turning down the faucet until the output is only turning down the faucet until the output is only a trickle . . .a trickle . . .

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ReceptionReception

Some drugs that DECREASE reception Some drugs that DECREASE reception are like a washcloth blocking the drain, are like a washcloth blocking the drain, causing less flow.causing less flow.

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Re-uptakeRe-uptake

Drugs that INCREASE Re-uptake Drugs that INCREASE Re-uptake block neurotransmitters (i.e., water) block neurotransmitters (i.e., water) from being received by the next from being received by the next brain cell (i.e., prevent them from brain cell (i.e., prevent them from going down the drain), thus going down the drain), thus causing more neurotransmitters causing more neurotransmitters to stay in the synaptic cleft (i.e., to stay in the synaptic cleft (i.e., the sink) and be reabsorbed (i.e., the sink) and be reabsorbed (i.e., go back “up the faucet”)go back “up the faucet”)

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Drugs that DECREASE Drugs that DECREASE re-uptake block re-uptake block neurotransmitters (i.e., the neurotransmitters (i.e., the water) from being reabsorbed water) from being reabsorbed (i.e., going back up the (i.e., going back up the faucet), and thus lead to a faucet), and thus lead to a greater amount of greater amount of neurotransmission to the next neurotransmission to the next brain cell (i.e., flow down the brain cell (i.e., flow down the drain)drain)

Re-uptakeRe-uptake

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From one brain cell to another From one brain cell to another – and back again . . .– and back again . . .

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““Uppers”Uppers” / (Stimulants) / (Stimulants)

Cocaine Cocaine

Amphetamine / MethamphetamineAmphetamine / Methamphetamine

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““Uppers”Uppers”

Increasing the number of Increasing the number of EXCITATORY neurotransmitter EXCITATORY neurotransmitter molecules (molecules (dopamine dopamine oror norepinephrinenorepinephrine) in the synapse ) in the synapse will elevate a person’s mood.will elevate a person’s mood.

Using our analogy, this would Using our analogy, this would mean more “water in the sink”mean more “water in the sink”

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““Uppers”Uppers”

What are the ways to get more What are the ways to get more “water in the sink?”“water in the sink?”

This can occur through INCREASED This can occur through INCREASED RELEASE of the excitatory RELEASE of the excitatory neurotransmitter (as in the case of neurotransmitter (as in the case of high-risk behavior), or through high-risk behavior), or through DECREASED RE-UPTAKE of DECREASED RE-UPTAKE of excitatory neurotransmitters, which is excitatory neurotransmitters, which is what occurs with cocaine what occurs with cocaine

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Post-acute Withdrawal SyndromePost-acute Withdrawal Syndrome

““PAWS” is a condition PAWS” is a condition experienced by many experienced by many addicts upon achieving addicts upon achieving abstinence. It can literally abstinence. It can literally take up to two years for take up to two years for the brain and nervous the brain and nervous system to heal and system to heal and “recalibrate” such that pre-“recalibrate” such that pre-use levels of normal use levels of normal neurotransmitter activity neurotransmitter activity are restored are restored

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During this time, in the During this time, in the case of individuals case of individuals addicted to stimulants addicted to stimulants (cocaine, for example),(cocaine, for example), the lower-than-normal the lower-than-normal amount of amount of dopaminedopamine transmission can result in transmission can result in the “under-stimulation” of the “under-stimulation” of brain cells, and resulting brain cells, and resulting depressive symptoms.depressive symptoms.

Post-acute Withdrawal SyndromePost-acute Withdrawal Syndrome

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““Downers”Downers” / (Depressants) / (Depressants)

AlcoholAlcohol Opiates Opiates

Heroin, Opium, Morphine, Codeine, Oxycontin, Heroin, Opium, Morphine, Codeine, Oxycontin, MethadoneMethadone

Sedatives / Hypnotics / Anxiolytics Sedatives / Hypnotics / Anxiolytics Benzodiazapines (Xanax, Valium, Librium, Benzodiazapines (Xanax, Valium, Librium,

Ativan, Klonopin)Ativan, Klonopin) Barbiturates (Seconal, Nembutal, Barbiturates (Seconal, Nembutal,

Phenobarbital)Phenobarbital) Soma, Methaqualone (QuaaludesSoma, Methaqualone (Quaaludes))

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““Downers”Downers” / (Depressants) / (Depressants)

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““Downers”Downers”

OpiatesOpiates DECREASE the RELEASE of DECREASE the RELEASE of excitatory neurotransmitters excitatory neurotransmitters ((dopaminedopamine, , &/&/oror norepinephrinenorepinephrine)), thus resulting in a , thus resulting in a soothing, calming effectsoothing, calming effectHowever,However, excessive excessive opiateopiate ingestion can ingestion can lower neurotransmission to the point at lower neurotransmission to the point at which slowed physical reactions can which slowed physical reactions can endanger life.endanger life.

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““All-Arounders” / All-Arounders” / (Psychedelics)(Psychedelics)

CannabisCannabis Marijuana, HashishMarijuana, Hashish

Hallucinogens Hallucinogens LSD, LSD, Mescaline, Peyote, Mushrooms Mescaline, Peyote, Mushrooms (Psilocybin) (Psilocybin) Ecstasy / “Ecstasy / “MDMA” / “Foxy”MDMA” / “Foxy” (hallucinogenic stimulants) (hallucinogenic stimulants) Ketamine, Rohypnol, GHB Ketamine, Rohypnol, GHB / “Date rape drugs” / “Date rape drugs”

(hallucinogenic depressants)(hallucinogenic depressants)

Inhalants Inhalants PhencyclidinePhencyclidine

PCPPCP (hallucinogenic depressant) (hallucinogenic depressant)

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Nature or nurture, Nature or nurture, genetics or environment?genetics or environment?

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All-AroundersAll-Arounders

EcstasyEcstasy deregulates the level of deregulates the level of serotoninserotonin, , the neurotransmitter involved in the regulation of the neurotransmitter involved in the regulation of sex, aggression, sleep and moodsex, aggression, sleep and mood

High doses of High doses of EcstasyEcstasy have been known to have been known to cause psychotic episodes, and even permanent cause psychotic episodes, and even permanent brain damage in some usersbrain damage in some users

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ReferencesReferences

American Psychiatric Association, (1994). American Psychiatric Association, (1994). Diagnostic and statistical manual Diagnostic and statistical manual of mental disorders, fourth edition.of mental disorders, fourth edition. Washington D.C.: Author. Washington D.C.: Author.

Milkman, H., & Sunderwirth, S., (1987). Milkman, H., & Sunderwirth, S., (1987). Craving for ecstasy: The Craving for ecstasy: The consciousness & chemistry of escape.consciousness & chemistry of escape. New York: Lexington Books. New York: Lexington Books.

Volkow, N.D., et al. (2001). Association of dopamine transporter reduction Volkow, N.D., et al. (2001). Association of dopamine transporter reduction with psychomotor impairment in methamphetamine abusers. with psychomotor impairment in methamphetamine abusers. American American Journal of PsychiatryJournal of Psychiatry, 158(3):377-382., 158(3):377-382.

Volkow, N.D., et al. (2001). Loss of dopamine transporters in Volkow, N.D., et al. (2001). Loss of dopamine transporters in methamphetamine abusers recovers with protractedmethamphetamine abusers recovers with protracted abstinence. abstinence. Journal Journal of Neuroscienceof Neuroscience, 21(23):9414-9418., 21(23):9414-9418.

http://en.wikipedia.org/wiki/Neurotransmitterhttp://en.wikipedia.org/wiki/Neurotransmitter

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Other Neurotransmitters and Other Neurotransmitters and examples of their actionsexamples of their actions

AcetylcholineAcetylcholine - voluntary movement of the - voluntary movement of the muscles; muscles;

NoradrenalineNoradrenaline - wakefulness or arousal; - wakefulness or arousal; GABAGABA (gamma aminobutryic acid) - motor (gamma aminobutryic acid) - motor

behavior; behavior; GlycineGlycine - spinal reflexes and motor - spinal reflexes and motor

behavior; behavior; NeuromodulatorsNeuromodulators - sensory transmission- - sensory transmission-

especially pain especially pain