Brain Addiction: Strengthen Reward Circuits

Addiction and cravings can feel like there are no way out of the self-defeating patterns.
But there are ways out…

In addictions, brain pathways are seeking relief, and activating brain centers–Unable to find the connections to REWARD pathways. Unfortunately, then, addictive behaviors activates and strengthen the ANTI-REWARD pathways.

THE WAY OUT: You must strenghen the REWARD and weaken the ANTI-REWARD pathways. You want to STRENGTHEN the REWARD pathways. Tools from the “step” programs can help. The social support, structure, and increasing self-esteem from working in a “step” program stengthens the reward system. Vitamins, herbs, medicinals and supplements can also strengthen important brain circuits. —

A good and balanced diet so you do not feel “sluggish” afterwards. You want to choose the types and amounts of foods that make you feel energized after the meal.

Supplements, such as Tyrosine, NADH and Rhodiola Rosea can help strengthen the dopamine, “pleasure” reward pathways. Vitamins given IV or orally –Such as B6, B3 (Niacin), B1, and Vitamin C –were used by Dr. Bob in the early days of AA and by many doctors and addiction centers since that time. Tryptophan or 5-HTP help with the calming quality of a strengthen the “calming”quality of serotonin reward pathway.

Good sleep at night is important so that the brain can go through its natural cycle of getting rid of its waste and building stronger circuits.

Volunteer work has been demonstrated to increase the strength of a part of the dopamine REWARD system called the VTA, and this may account for the central and successful role of helping others and mentoring in “step” groups.

Exercise increases opioids, the VTA dopamine (REWARD system) and normalizes the HPA axis with reduction in the CRF pulses. (Anti-Reward system)

Different types of meditation can strengthen the GABA REWARD system of the brain.

Baclofen, a muscle-relaxant drug, may both blunt the limbic reaction (Anti-Reward) AND prompt a more normal response from prefrontal regions (Reward). Acamprosate works on a receptor called NMDA and is helpful for some. Naltrexone and Suboxone work on the opioid system and also helps some individuals.

However, you must understand that the most difficult part of stopping addictions is that when you stop, the brain circuits have become highly “wired” to return to, and strengthen, the self-destructive, anti-reward pathways.

You need support, patience and understanding to get through this difficult phase.

You want to weaken the ANTI-REWARD systems because these make your brain agitated and “on the hunt” for relief or a “fix.”

 

Avoiding things that strengthen the anti-reward system:

A poor diet, with repeated spikes in blood sugar, will increase an enzyme called PKC, which will reduce the D2 receptors–reducing the REWARD system of dopamine.

Repeating one’s addictions strengthens the anti-reward system of the brain.

Physically placing yourself where you have done addictive behavior in the past will also strengthen the signal of the anti-reward pathways.

Finally, thinking about the substance, and thinking about how you are going to get more, increases the anti-reward systems.

In a healthy adult brain, the compulsions that flow from the limbic system are normally held in check by the more recently evolved prefrontal cortex (PFC)

 The PFC is a better judge of weighing choices, and if it were in charge, it would never choose the long-term pain that results from addictive behaviors.

When the PFC is weak, the Limbic System works to try to satisfy its urges, pain and anxiety. A weakened PFC makes people particularly prone to drugtaking and addiction

What weakens the PFC?: Higher levels of stress (trips, meetings, deadlines, conflict) can weaken, or overload, the prefrontal system and increase the vulnerability to drugtaking and addiction.

Cycle of Addiction

Drug addiction has elements of both an impulse control disorder and a compulsive disorder that are mediated by separate but overlapping neural circuits. The individual with an impulse control disorder experiences an increasing sense of tension or arousal before committing the impulsive act such as drug-taking; pleasure, gratification or relief during the act; and in some cases, regret, self-reproach or guilt following the act. The individual with a compulsive disorder feels anxiety and stress before the compulsive, repetitive act, and relief from stress by performing the act. In the progression from an impulsive disorder to a compulsive disorder, the motivation for the behavior shifts from positive reinforcement to negative reinforcement, when removal of the aversive state increases the probability of the behavior. Drug addiction follows this pattern in a collapsed cycle of addiction involving 3 stages:

  • Binge/intoxication;
  • Withdrawal/negative affect; and
  • Preoccupation/anticipation (craving).

Addiction involves a long-term persistent plasticity of the neural circuits that control 2 different reward systems: declining function of brain reward systems driven by natural rewards and stimulation of anti-reward systems that bring on aversive, or painful states.

Brain Reward System
Studies of the acute reinforcing effects of drugs of abuse in the binge/intoxication stage have identified the neurobiological substrates involved in the reward response. Drugs with the potential for abuse and dependence, such as the opioid analgesics, initially produce positive reinforcing effects from actions at the ventral tegmental area in the midbrain and the nucleus accumbens and amygdala of the basal forebrain. Activation of the mesocorticolimbic dopamine pathway is the primary route of positive reinforcement in addiction for psychostimulant drugs, but the opioid peptides (endorphins), serotonin, and gamma-aminobutyric acid (GABA) have key roles for nonpsychostimulant drugs. These so-called “reward neurotransmitters” induce hedonic effects of euphoria and a feeling of well-being.

Brain Anti-reward System
Withdrawal from a drug of abuse induces symptoms of negative affect such as dysphoria, depression, irritability, and anxiety.

Dysregulation of brain reward systems involves some of the same neurochemical pathways implicated in the drug’s acute reinforcing effects, but in this case, they represent an opponent process. During acute abstinence, increases in brain reward thresholds (a higher set point for drug reward) are a consequence of altered reward neurotransmitters. This in turn may contribute to the negative motivational state of withdrawal and vulnerability to relapse. Neurochemical changes during opioid withdrawal include decreases in dopaminergic and serotonergic transmission and increased sensitivity of opioid receptor transduction mechanisms. Escalating doses of opioids, like those seen in the human pattern of morphine or heroin use, are associated with profound alterations in the function of mu-opioid receptors. A decrease in baseline reward mechanisms leads to an increase in drug intake to compensate for the shift in reward baseline.
For the addict, the situation deteriorates. Stress response systems of the body contribute to the negative emotional state associated with abstinence and can exacerbate drug taking throughout the addiction cycle. In response to taking the drug, the neuroendocrine system kicks in to attempt to restore the brain to normal function.  Chronic drug use adversely affects the hypothalamic-pituitary-adrenal axis,  disrupting regulation of hypothalamic corticotropin releasing factor (CRF). Particularly important is activation of CRF in the extrahypothalamic brain stress system of the extended amygdala. The extended amygdala is a structure comprised of the bed nucleus of the stria terminalis, the central nucleus of the amygdala, and a transition zone in the medial subregion of the nucleus accumbens and a major projection to the lateral hypothalamus. CRF controls hormonal, sympathetic, and behavioral responses to stress. During acute withdrawal of the drug, production of adrenocorticotropic hormone, corticosterone, amygdala CRF, norepinephrine, dynorphin, and inhibition of neuropeptide Y induce brain arousal, stress-like responses, and a dysphoric, aversive state. The activation and recruitment of brain and hormonal stress responses contribute to a deviation in brain reward set point. These are the sources of negative reinforcement that lead to compulsive drug-seeking behavior and addiction

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