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Sonoma County Gazette
Wellness Corner by Dr. Gary Pace

Addiction in the Modern World

Aug 30, 2017
by Gary Pace M.D.


“The opposite of addiction is not sobriety, it is human connection,”Johann Hari.

Clearly something is out of balance in our society-- the most economically well-off in human history, yet with ever-increasing human want and suffering.

Obesity. In 1990, no state had a rate above 15%. In 2015, 44 states were over 25%. Something has changed, and it isn’t the genetics of the population.

The exploding “opioid epidemic.” The overwhelming appetite for opioid pain medicine in our society has serious consequences.

“Death by Despair.” Suicide and overdose deaths in white middle class males who are finding themselves essentially outside of the functioning economy has surpassed those by car accidents.

Changing Perspectives ~ The lens that we have looked at these problems has evolved over time. Traditionally, we have seen addiction as a moral failure, needing religious and legal solutions. The more recent “progressive” approach sees a medical problem, i.e., the person has a ‘substance use disorder’ from a genetic predisposition that interacts with powerful substances leading to a disease-state. What role does environment play in this equation?

Some studies in the 1960s showed that rats in a cage consistently chose cocaine water over pure water. They then became consumed by the cravings, would stop eating, and eventually died. Presumably, the drug was so powerful that it overwhelmed the organism’s usual homeostasis.

Bruce Alexander took this work to another level. He recognized that the cages the rats lived in were terrible environments and wondered if he made a better area for them, a ‘rat park,’ would they have the same compulsion to use the drugs? Remarkably, he found that those in a nice setting who had contact with other animals consistently walked away from the drugged water supply, and none died.

At that time, there was an inadvertant human analogy to the Rat Park studies—many vets became addicted to heroin when serving in Viet Nam. Followup showed that 95 % of the soldiers who became addicted when serving overseas did not exhibit addictive behavior upon their return to their home environment.

These findings suggest a third view of addiction: not the perspective that it is a moral failing, nor the view that it is due to a powerful substance interacting with a “disease.” Instead, it could be seen as an issue of adaptation to a challenging environment.

NeurotransmittersMediate between Environment & Human Experience

Dopamine is the neurotransmitter that stimulates the reward center of the brain, and it seems to be where addictive behaviors originate. The use of powerful drugs, high fat foods, gambling, and sex all bring about a surge of dopamine, and once these areas of the brain are stimulated, some people want more. Of course, a key questions is, “Why do some people chase after these risky ways of getting dopamine and others don’t?”

A recent study showed that folks with lower social status and lower degree of social support had fewer dopamine receptors in the brain, which leads to less motivation and enthusiasm. Also important is that the folks with higher numbers of receptors were less likely to look to drugs or over-eating to stimulate these reward pathways.

Dr. Nora Volkow, a nationally known addictionologist, found that people with fewer dopamine receptors desired Ritalin when they consumed it. Those with more receptors found Ritalin unpleasant, and they were much less likely to continue using the drug even after trying it one time. She also found that regular use of these substances led to lower numbers of the receptors, leading to a downward spiral of a worse sense of well-being without external stimulation. Finally, she found that decreased dopamine receptors correlated with decreased activity in the pre-frontal cortex, the area that is the planning and control part of the brain. So, in addition to having more difficulty feeling pleasure, these people had less impulse control and less ability to delay gratification.

Treatment ~ Next month, we will look at evidence that environment can actually change the dopamine receptors which in turn influences human behavior. Then we can look at treatment approaches that address environmental issues as well as the spiritual and biochemical. This emphasis is promising, since environment is more changeable than moral fiber or genetics.



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