|
UNDERTANDING SUBSTANCE ABUSE To understand the significance of the Parallax Center's work, it is important to understand the neurochemical mechanisms by which people become addicted to a chemical substance, whether it be alcohol, heroin or a stimulant like cocaine. The place to start is in the brain, where a number of reinforcement mechanisms exist -"reward pathways"- that depend on several different biochemical substances called neurotransmitters for normal functioning. The neurotransmitters are dopamine, serotonin, opiate peptides and gamma-aminobutyrate (GABA). Neurotransmitters are responsible for regulating mood. Dopamine, serotonin, GABA and opiate peptides are necessary to experience feelings of euphoria, energy, self-esteem and a sense of well being. Substances of abuse, such as heroin, cocaine and alcohol, cause a magnification of the effects of these neurotransmitters by overstimulating the receptor sites in the brain associated with each neurotransmitter. The elevation in mood caused by this overstimulation is so pleasurable that it creates a desire for continued use of the substance. However, when overstimulation occurs, the brain reacts by reducing production of the neurotransmitters to attempt to maintain a normal level of neurotransmitter activity. Consequently, more frequent and higher doses of the substance of abuse are necessary to induce pleasure. Furthermore, when the pleasurable "high" from the substances wears off, the brain experiences more acutely the lack of neurotransmitters caused by reduced production, and symptoms such as depression and anxiety begin. At this point, memories of the euphoric experience of the abused substance cause a craving for more of the substance, and the cycle of use continues. Recognizing Protracted Abstinence Syndrome When a substance abuser discontinues regular use, it takes weeks or months of abstinence after complete detoxification before the brain's pleasure mechanisms are able to achieve equilibrium through an increase in the production and utilization of neurotransmitters to levels that can maintain a stable and optimistic mood. During this period, identified first by Martin and Sloan in 1968, and then by Dr. Ockert and others in the early 1980s, as the protracted abstinence syndrome, substance abusers experience distinct stages of physical and psychological symptoms that can last from six months to eighteen months. This period is the time of greatest relapse; most substance abusers in the U.S. relapse within three months of detoxification (estimates range as high as 98%). The symptoms of protracted abstinence change as the patient proceeds through its various stages (as identified in Rawson's neurobehavioral model). Stages include temporary rebound ("pink cloud") which occurs 10 to 45 days after detoxification and is characterized by overconfidence, an inability to initiate change and episodic cravings; the "wall phase" which occurs 45 to 120 days into abstinence and is characterized by intense and often sudden onsets of anhedonia (lack of pleasure), mood swings and depression as well as justification for relapse; and the "adjustment" phase, which lasts 120 to 180 days into abstinence and is characterized by job dissatisfaction, relationship problems and lack of goals. Physiologically, the body also changes during the protracted abstinence period. In the case of opiate withdrawal, for example, body temperature, blood pressure and pulse rate shift from above to below pre-addiction levels. In the case of alcohol, cocaine and Benzodiazepines similar changes in physiological activity are associated with sleep disturbance, lack of energy, transient attention deficit, impulsive and erratic behavior, and low frustration tolerance. Psychological and emotional signs and symptoms may include depression, anxiety, self-doubt and boredom, coupled with confusion, hostility, inappropriate coping responses and fear.
| |
|
145 EAST 32ND STREET |