Recovery Plus: Workplace wellbeing your library’s essential reference September 2016 49 Carlton Erickson PhD is a research scientist who has been studying the effects of alcohol on the brain for over 45 years. He is the Pfizer Centennial Professor of Pharmacology and director of the Addiction Science Research and Education Center, College of Pharmacy, University of Texas. He has published over 150 scientific and professional articles, has co-edited and co-authored books and is associate editor of the scientific journal Alcoholism: Clinical and Experimental Research. He is also a recipient of the Betty Ford Center Visionary Award 2000. He has spoken to about 70,000 professionals and people in recovery since 1978. To read Carlton Erickson's books on neurochemistry and addiction, go to http://sites. utexas.edu/erickson. “If addictions are a medical disorder, why do we treat them behaviourally? Simple. Behavioural therapies can change brain chemistry!” explains neuroscientist Professor Carlton Erickson. About the author 5-6% became dependent in the first year of use. Fully 80% of people who became dependent on cocaine over the 10 years became dependent in the first three years. These studies deserve more replication, but they are interesting in that they begin to break down some myths. Early vs late onset. So, although it “looks” as if most people evolve from abuse to dependence, people can become dependent during their first year of using drugs, including alcohol. People in recovery seem to understand that some people become “instantly” dependent with the first use of a drug (including alcohol). There is only one explanation, and it lies in the physiology of the medial forebrain bundle, or MFB, also known as the mesolimbic dopamine system. Dependence is not “lack of will power” – problems with the frontal cortex portion of the MFB produce a pathological impairment of decision-making. Basic neurobiology: neurotransmitters involved in dependence. Dependence is probably due to a functional dysregulation – meaning: they aren’t working right! – of neurotransmitter chemicals in the MFB. These include dopamine (which is affected by cocaine, amphetamines or alcohol), serotonin (alcohol or LSD), endorphins (alcohol or opioids such as heroin), gamma-aminobutyric acid (alcohol or benzodiazepines – antianxiety agents), glutamate (alcohol) and acetylcholine (nicotine or alcohol). The dysregulation could be related to too much or too little neurotransmission, abnormal breakdown of neurotransmitters or abnormal receptor function. How does it come about? Is it due to genetic ‘malfunctions’, to druginduced changes, or to other aspects of the environment? Neurobiological research points to genetics and drug-induced changes as being primary causes of dependence, with the environment being a major, though secondary, contributor to drug abuse and dependence. The rationale based on genetics. Abnormal genes lead to abnormal proteins. This results in abnormal transmitter-synthesising enzymes, abnormal transmitter-breakdown enzymes, or abnormal receptors. This is the cause of neurotransmitter dysregulation in the pleasure pathway. Impaired control appears to be due to this brain-chemistry disruption. It is the reason that scientists and clinicians now believe that dependence is a chronic medical brain disease. Today's treatment options include some or all of the following: • traditional – 12-step programmes/abstinence • talk – inpatient/outpatient/aftercare • harm reduction, including substitution drugs • brief motivational counselling, cognitive behavioural therapy, motivational enhancement therapy, ‘significant others’ therapy, vouchers • medical treatment – new medications to enhance abstinence, anticraving medications, vaccines, drugs to alleviate withdrawal and more. So, if addictions are a medical disorder, why do we treat them behaviourally? What is the similarity between behavioural or talk therapies and pharmacotherapies in the way they work? Simple. Behavioural therapies probably change brain chemistry! Look out for the research.
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