On drugs and the brain: In the following article, we will attempt to explain the physical effect that chemical dependency to drugs has on the brain, and why both detox and treatment is often necessary in order to counteract those physical effects.
Drugs, whether it is cocaine, marijuana, opioids or hallucinogens, are chemicals. The human brain is essentially one large biochemical processor; the neurons in our brains release and receive various neurotransmitters, which dictate how we feel, how we process information, and how we react to stimuli. Drugs essentially tap into that chemical communication system of the brain, and interfere with the way nerve cells normally send, receive and process information.
How the relationship between drugs and the brain works varies depending on the substance being used. Some narcotics, such as heroin or marijuana, have within them chemical components that structurally mimic naturally-occurring neurotransmitters like dopamine. However, drugs like opiates do not actually activate nerve cells in any type of natural way, and instead flood the nervous system with abnormally high amounts of an otherwise selectively-produced neurotransmitters. Other drugs, such as cocaine, amphetamines, and similar stimulants, tend to incite nerve cells to release atypically large amounts of natural neurotransmitters which both rattle communication channels and deliver a vastly magnified “message”. The rush that stimulant users experience is an example of that artificially magnified neurological messaging.
When one engages in long-term drug use, the brain becomes accustomed to overwhelming amounts of dopamine (or other neurotransmitters) and thereby starts producing less on its own. Over time, the decrease in neurotransmitter production leads to a decrease in the number of receptors that can receive signals from those neurotransmitters. As a result, the brain becomes incapable of allowing chronic drug users to experience pleasure like they were once accustomed to. Individuals become addicted to their substance of abuse because of this continued altering of brain chemistry, and are unable to receive gratification from normally gratifying experience due to this prolonged chemical imbalance.
The first step in treating drug abuse or addiction is understanding that it is a chronic illness, not a moral failing, and that as a chronic illness, it has relapse rates on par with those of other chronic illnesses, such as hypertension, both of which can be caused by lifestyle choices, and can also have a genetic component, but are standalone illness. As a chronic illness, drug dependency requires medical care. Simply stopping the consumption of drugs leads to withdrawal symptoms, which is the body’s response to being deprived the artificially elevated levels of neurotransmitters that have led it to produce less of its own. The nature and severity of withdrawals depends on the specific substance of abuse – improper detoxification from alcohol or benzodiazepines (Valium, Xanax, Ativan) can lead to seizures that can be fatal. Opioid (heroin, Oxycontin) withdrawal, while not fatal, causes severe flu-like symptoms that are highly uncomfortable and discourage opioid users from stopping.
The standard, when treating chemical dependency, is the administration of certain medications to address withdrawal symptoms, under the care of a medical professional, along with therapy or counseling to address emotional and psychological issues as they arise. There are a number of medications that in combination can treat the use of drugs and the brain chemistry affected by drugs. Buprenorphine, for example, an active ingredient in Suboxone, Subutex, and Sublocade, operates on the same neural receptors as full opioid agonists like heroin or fentanyl, and thus can help block or ease withdrawal symptoms from those drugs.
Some drugs are only administered short-term during the acute phase of drug or alcohol detox, while others can be administered long-term to prevent cravings and reduce the risk of relapse in early recovery. Many drug addicted individuals experience what is known as post-acute withdrawal syndrome (PAWS) which can best be described as a longer-term fallout after prolonged drinking or drug use. Symptoms of PAWS can include depression, anxiety, physical aches, migraines, and temperature sensitivity, and can last for months or even in some cases years. Oftentimes additional non-narcotic medications can be prescribed to alleviate post-acute withdrawal symptoms. In addition, newer forms of treatment like TMS therapy have shown to help with opioid use disorder in research trials. And clinical therapy along with involvement in peer support groups like SMART Recovery are essential in relapse prevention.
Since 2003, the Delray Center for Healing has provided exceptional psychiatric and therapeutic care for mental health, eating, and substance use disorders. To learn more about our philosophy and treatment approach, download our free e-book, “Psychiatry Redefined,” written by our founder and medical director, Raul J. Rodriguez, MD.