A Nervous Systems understanding of Addictions

A Nervous Systems understanding of Addictions

An addiction is anything the body, mind or Nervous systems crave to feel at ease.

Addiction is a catch-all term for a complex behavioral disorder or set of physical symptoms.

The most obvious symptom is that addicts reach a point where it is much easier to give in then to control their own actions.

There are very different types of addicts that make that can determine if the treatment will be a success of failure from the very beginning.

There is always a reason for the behavior of an addict.  Most addicts are completely unaware that they are becoming an addict.

Codependency, dependence and Enabling Substance Abuse Behavior

When drugs enter the brain, they bind to receptors and trick us into feeling a response- and that response is the ‘high’. If drugs were not able to cause these good feelings, they wouldn’t be abused. That last statement you read is the furthest from the truth.  Most people that has been on a drug for a long period of time no longer feel that so called high or good feeling anymore.  In fact many people on the same drugs for a long of a period of time don’t even like the way they feel when they take the drug.  In fact many of them are no longer getting any results from the medications at all.

There are many different kinds of drug abuse, which one are you and how will you resolve the problem.

We call it a disease for one reason only. We now can be treated by another drug.  Addiction is no more a disease than cataracts.

The definition of a disease is anything that feels or looks abnormal to the human body.  You can see how that definition was left wide open to interpretation.

So what kind of addiction do you have?  Most likely you fall into the most common group that went to their doctor and complained about a pain or planned a surgery to correct a pain problem.  So you were placed on a pain medication to comfort you before the surgery and a follow-up of pain medication after the surgery until the pain should have naturally gone away.

The number one pain addiction in the entire world comes from the prescribing doctor not having a plan of action to help you get off the pain medication after the surgery.

So who else is substance dependant?

1. The patient that could not be clinically diagnosed but placed on pain medications.
2. The wrong diagnosis, leads us to the wrong treatment.
3. The right diagnosis with the right treatment, but left on that treatment for to long.
4. The leftover results of surgery.
5. An injury that did not heal because drugs don’t heal.
6. The trauma patient that was told 4 to 6 weeks of pain medication is all they will need to get well.
7. The chronic disease patient that is given very little to no options except pain medication.
8. The cancer patient that was not told it would sooner or later fail.
9. The cancer patient that beat the cancer but now a serious drug addict that will die shortly from the medication.

10. The new born infant that had no idea their mom was on pain medication.

11. The local street drug addict who starts out enjoying the high, but now is struggling to free themselves from the drugs.

12. The drug addict that is running away from something.

After we discover what is your cause for taking the medication (not what kind of addict are you) then we can really figure out how to get you off that medication with the least suffering and rebound.

Pain is the number one cause for the use of addiction medication.  If we cannot find the cause don’t bother getting off the medication and going thru all that suffering just to be told you have to go back on the drug.

So people that are suffering with chronic pain from an unknown source need to place all their energy to discover what is causing the pain.

Pain is the most debilitating and destructive way the human body can destroy itself.  Pain has an unhappy isolation that comes with it and just makes the condition even worse.  You are all alone when living in a body of pain.  Sleep is one of the only ways to get away from pain for the few that can still sleep without sedating themselves each night.  Have I painted a gloomy enough picture?

Are there really answers to all these people who are dependent on pain medications?  There are answers to most of these situations but going to a detoxification clinic is only half the battle.  Let’s compare cigarette smoking to drug addiction.  There both serious addictions.  You have heard and seen how difficult it is to stop cigarette smoking.  Pain drug dependence is 2,000 times more difficult to stop.  Why?
Pain medication takes the place of the most important function of the human body.  Natural Pain, inflammation, comfort and mood support.  Your mood changes make who you are and your comfort changes the way you act, inflammation and pain dictates what you are allowed to do each day.  You no longer have control of body and parts of your life.  Think how uncomfortable it would be if you could not breathe.

So how does anyone get better and off the medication when they really don’t even know what the medication has done to their body?  We read all kind of things that tell us what the pain medication has done to our brain, nervous systems and body but do we know for a fact that this is all there is to it?  There is so much more then we are told.  Do we understand the psychological memory component involved within our limbic region or the connection of our thalamus to this problem.  Do we really know what ingredients/chemicals were taken out of our body that cannot be replaced by simple foods?  If we cannot fully restore the body, brain, nervous systems and deficiencies we are just taking the patient through a miserable detoxification and setting them up for a repeat of the past.

Getting the real understanding what happens to your mind, body and the deficiencies shows us a more humane and easier way to get though the detoxification.  During the detoxifications you are also setting yourself up to prevent the need for medication and fulfilling the body’s needs of all the deficiencies created by the drugs.

Just some basic information known to science is all pain medications deplete the body B vitamins.  This is just the start to a much more serious depletion problem.

It is important that the deficiencies are taken care of weeks before the detoxification even starts.  This alone will relieve the withdraw symptoms and prevent the need for the chosen drug.

It is important that we figure out what kind of patient we are dealing with:

1. Drug addict for no apparent reason, it started out as enjoyment. = Addiction/Substance abuse.
2. Prescribed drug for symptom(s) that are now gone. = Codependent/Substance abuse.
3. Prescribed drug for a symptom(s) that are not gone. = Codependent
4. Chronic pain without a clinical symptom. = Codependent
5. Patient having more or different symptoms then what they were originally diagnosed. = Codependent
6. No apparent reasons at all with the exception of withdraw symptoms (life is great). = Addiction
7. Functions better in life staying on the pills (Brain clarity). = Codependent
8. Stockpiles prescription medication (fear of symptoms). = Codependent
9. Long term self medicating for no physical symptoms. Addiction/Substance abuse.

We also need to know the following:

• Male or Female
• Age
• Height
• Weight
• Small history of patient symptoms.
• Immediate family history related to your symptoms
• List of all your symptoms, even trivial ones; include all that have no connection. to the addictive medications. (List all medications and Vitamins).
• List of other addictions or cravings.
• Explain cause of the symptoms (if known)

There are so many drugs that cause these addictions and they all have to be treated differently to get the best results.  Some of the more common drugs are:

Morphine the KING of pain relievers and most common used, also known as narcotics.

Opioids

Opioids (pronounced oh-pee-oyds) were first made from the juice of the opium poppy. But many are now manmade in a laboratory. There are different types of opioid painkillers – strong ones and weak ones.

Strong opioids include:

• Morphine
• Diamorphine
• Fentanyl and Alfentanyl

• Buprenorphine (Subutex, Temgesic, Buprenex, or Suboxone [buprenorphine:naloxone 4:1 preparation]) is a semi-synthetic opioid that is used to treat opioid addiction in higher dosages (>2mg) and to control moderate pain in non-opioid tolerant individuals in lower dosages.

Know matter what your doctor tells you or what you read Suboxone is one of the most amazing and most dangerous drugs on the market.  It can relive the most severe chronic pain when all else fails.

We place a bit of caution on this drug.  It is extremely addictive and works so well you don’t want to discontinue it.  It was meant for short term use to get off opioids but it worked so well it now is being prescribed for pain.

If you only have a little bit of time left to live and don’t want the memory of suffering as your last thought, then Suboxone may be the drug for you.  Just remember it is for short term use.  We recommend it for no longer than 4 months at the lowest dose possible to stay pain free.

• Oxycodone
• Hydromorphone
• Methadone

These are the strongest painkillers and are commonly used to treat cancer pain. You can only get them on prescription from your doctor. Used properly, strong opioid drugs do not have many side effects that cannot be tolerated but are used when there is a life coming to the end.

Weak opioids include

• Codeine
• Tramadol

Your doctor or nurse may prescribe non opioid drugs to take alongside weak or strong opioids to give you the best pain relief possible.

Morphine

There are lots of different preparations of morphine that can be given in different ways, including

• An ‘immediate release’ liquid or tablet that you take every 2 to 4 hours
• ‘Slow release’ tablets, capsules or powders that you take every 12 or 24 hours
• A liquid that can be injected into a vein or given through a drip
• A liquid that can be given through a small needle under the skin
• Suppositories inserted into the back passage
• Tablets you dissolve under your tongue (transmucosal tablets)
• Patches you stick on to the skin (transdermal patches)

When you start taking morphine, you will normally be given the more short acting immediate release type. You take it at least every 4 hours. That way your dose can be adjusted quickly and easily until your pain is controlled. Your doctor or nurse will give you instructions on how much morphine to take and when to take it. Their instructions will allow you some flexibility so that you can take enough to control your pain.

If the dose you are taking is not enough for you, you will probably find that your pain comes back before the next dose of morphine is due. It is important to keep a note of how much morphine you take and when. Then your doctor or nurse can work out how much you need every 24 hours.

Once your doctor or nurse knows how much morphine you need to control your pain, they can give you slow release tablets containing enough morphine to control your pain for 12 or 24 hours. The slow release tablets are also called ‘sustained release’ morphine or ‘MST’. The morphine is released slowly from the tablet and controls your pain for long periods. This is more convenient than taking tablets every 4 hours.

Remember – you must take slow release tablets regularly or they won’t work. When you start taking them, it can take up to 48 hours for the dose to steady in your bloodstream. They are not the sort of tablets that you can take now and again.

You should also have a supply of the ‘immediate release’ type morphine to take, in case you have any extra pain while you are taking slow release tablets. This pain is called ‘breakthrough’ pain. You should keep a note of what you take so that you can tell your doctor and nurse. If you frequently need extra doses, you may need a higher dose of the ‘slow acting’ tablets.

With morphine, you often have other drugs that help to reduce pain. For example, you may also have an anti-inflammatory drug to help control bone pain or to reduce swelling that is adding to the pressure caused by the cancer.

Diamorphine

Diamorphine is a form of morphine that is very easy to dissolve in very small amounts of water. So it may be used when morphine needs to be given by injection, especially in a syringe driver. This is a battery operated or clockwork pump. It gives liquid from a syringe through a small tube placed just under the skin. The pump can give tiny amounts continuously. So it is used when good regular pain control is needed for people who have sickness or find it difficult to swallow tablets. It may be used for people who are terminally ill, but being cared for at home. A nurse changes the syringe every 24 or 48 hours.

Fentanyl and Alfentanil

Fentanyl is a manmade (synthetic), slow release opioid. It is also called Durogesic. The drug is absorbed through a patch stuck onto your skin. So you don’t have to take any tablets or have any injections. When you start fentanyl, it can take up to 72 hours to get the right level of drug in your bloodstream. So your doctor will ask you to carry on taking your previous painkillers for a while.

While you have a fentanyl patch, you should also have a supply of the ‘immediate release’ type morphine or oxycodone to take, in case you have any extra pain. When you’ve had a fentanyl patch, it takes up to 72 hours to get the fentanyl out of your system once you stop using it. So any other painkiller you move onto will have to be phased in gradually as the fentanyl is phased out.

A small study has shown that Fentanyl may not be absorbed as well in people who have had severe weight loss (cachexia).  So in this situation, doctors may prescribe a different type of drug.

Fentanyl is also available as a lozenge that you dissolve under your tongue. It is called Actiq. It works very quickly and gives fast pain relief. It is helpful for pain that comes on quickly, such as when you need to have a dressing changed or move around. This type of pain is called ‘incident pain’.

Fentanyl has recently become available as a tablet that is placed between your gum and cheek, and dissolves.  It is called Effentora and is used for ‘breakthrough’ pain.

Alfentanyl is a type of fentanyl. It is also called Rapifen. It dissolves in water and so may be used when fentanyl needs to be given by injection, especially in a syringe driver. This is a battery operated or clockwork pump. It gives liquid from a syringe through a needle just under the skin. The pump can give tiny amounts continuously. So it is used when good regular pain control is needed for people who have sickness or find it difficult to swallow tablets. It can be used for people who are terminally ill, but being cared for at home.

Alfentanyl is also available as a lozenge that you dissolve under your tongue. It works very quickly and can be used for breakthrough pain.

Buprenorphine

Buprenorphine is more commonly known by its trade name, Transtec. It is stick on patches, similar to fentanyl. They are useful if you find swallowing pills and medicines difficult. It takes at least 24 hours for the right level of the drug to build up in your bloodstream when you start the patches. You may need to continue with your other painkillers during this time, so follow your doctor’s advice.

While you have a Transtec patch, you should also have a supply of the ‘immediate release’ type morphine or oxycodone to take, in case you have any extra pain. It takes a few days to get the drug out of your system when you stop taking it.

Oxycodone

This opioid can be useful if you have both bone and nerve pain. Particularly if morphine has not helped your pain or has given you unpleasant side effects. Oxycodone is available as an injectable liquid, a liquid that you drink or as capsules to swallow. These preparations are called OxyNorm. There is a slow release tablet called OxyContin. You should have a supply of the ‘immediate release’ type oxycodone to take, in case you have any extra pain while you are taking the slow release tablets.

Hydromorphone

Hydromorphone is a strong opioid. It is also called Palladone and is available as

• Immediate release capsules
• Slow release capsules that you take every 12 hours (Palladone-SR)
• An injectable liquid

While you are taking slow release tablets you should also have a supply of the ‘immediate release’ type hydromorphone, in case you have any extra pain.

Methadone

Methadone is a strong opioid. It works very well at controlling nerve pain. It is available as

• Tablets
• A liquid that you swallow
• An injectable liquid

Codeine

Codeine is a weak opioid and is usually the first choice of drugs if non-opioid drugs are not enough to control your pain. A number of tablets combine codeine and paracetamol, for example co-codamol or co-dydramol.

Tramadol

Tramadol is a weak opioid and is available as

• Tablets or capsules (Tramacet or Zamadol)
• Slow release tablets or capsules that you take every 12 hours (Dromadol, Nobligan or Tradorec)
• Tablets that dissolve on your tongue (Zamadol melt)

While you are taking slow release tablets you should also have a supply of the ‘immediate release’ type tramadol, in case you have any extra pain.

Morphine has a high potential for addiction; tolerance and psychological dependence develop rapidly, although physical addiction may take several months to develop.

Addiction may refer to Substance dependence (drug addiction) or to Behavioral addiction.

Historically, addiction has been defined with regard solely to psychoactive substances (for example alcohol, tobacco and other drugs) which cross the blood-brain barrier once ingested, temporarily altering the chemical milieu of the brain.

Many people, both psychology professionals and laymen, now feel that there should be accommodation made to include psychological dependency on such things as gambling, food, sex, pornography, computers, video games, internet, work, exercise, idolizing, watching TV or certain types of non-pornographic videos, spiritual obsession (as opposed to religious devotion), pain [1], cutting and shopping so these behaviors count as ‘addictions’ as well and cause guilt, shame, fear, hopelessness, failure, rejection, anxiety, or humiliation symptoms associated with, among other medical conditions, depression and epilepsy.[1][2][3][4]

Drug addiction

Main articles: Substance dependence and Substance use disorder

The related concept of drug addiction has many different definitions. Some writers give in fact drug addiction the same meaning as substance dependence, others for example provide drug addiction a narrower meaning which excludes drugs without evidence of tolerance or withdrawal symptoms.

The American Society of Addiction Medicine has this definition for Addiction: Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in the individual pursuing reward and/or relief by substance use and other behaviors. Addiction is characterized by impairment in behavioral control, craving, inability to consistently abstain, and diminished recognition of significant problems with one’s behaviors and interpersonal relationships. Like other chronic diseases, addiction involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

Substance dependence

Main article: Substance dependence

According to the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), substance dependence is defined as:

“When an individual persists in use of alcohol or other drugs despite problems related to use of the substance, substance dependence may be diagnosed. Compulsive and repetitive use may result in tolerance to the effect of the drug and withdrawal symptoms when use is reduced or stopped. This, along with Substance Abuse are considered Substance Use Disorders….” [5]

Substance dependence can be diagnosed with physiological dependence, evidence of tolerance or withdrawal, or without physiological dependence.

DSM-IV substance dependencies:

303.90 Alcohol dependence

304.00 Opioid dependence

304.10 Sedative, hypnotic, or anxiolytic dependence (including benzodiazepine dependence and barbiturate dependence)

304.20 Cocaine dependence

304.30 Cannabis dependence

304.40 Amphetamine dependence (or amphetamine-like)

304.50 Hallucinogen dependence

304.60 Inhalant dependence

304.80 Polysubstance dependence

304.90 Phencyclidine (or phencyclidine-like) dependence

304.90 Other (or unknown) substance dependence

305.10 Nicotine dependence

Behavioral addiction

Main articles: Behavioral addiction and Addictive behavior

The term addiction is also sometimes applied to compulsions that are not substance-related, such as problem gambling and computer addiction. In these kinds of common usages, the term addiction is used to describe a recurring compulsion by an individual to engage in some specific activity, despite harmful consequences, as deemed by the user himself to his individual health, mental state, or social life.

^ Taylor, C.Z. (March 2002). “Religious Addiction: Obsession with Spirituality”. Pastoral Psychology (Springer Netherlands) 50 (4): 291–315. doi:10.1023/A:1014074130084. Retrieved 2008-03-24.

^ “Depression”. The Columbia Electronic Encyclopedia. Columbia University Press. 2007. Retrieved 2008-03-24.

^ Nowack, W.J. (2006-08-29). “Psychiatric Disorders Associated With Epilepsy”. eMedicine Specialities. WebMD. Retrieved 2008-03-24.

^ Beck, D.A. (2007). “Psychiatric Disorders due to General Medical Conditions” (PDF). Department of Psychiatry, University of Missouri-Columbia. Retrieved 2008-03-24.

^ DSM-IV & DSM-IV-TR:Substance Dependence

Withdrawal

Cessation of dosing with morphine creates the prototypical opioid withdrawal syndrome, which unlike that of barbiturates, benzodiazepines, alcohol, sedative-hypnotics &c. is not fatal by itself in neurologically healthy patients without heart or lung problems; it is in theory self-limiting in length and overall impact in that a rapid increase in metabolism and other bodily processes takes place, including shedding and replacement of the cells of many organs.

None the less, suicide, heart attacks, strokes, seizures proceeding to status epilepticus, and effects of extreme dehydration do lead to fatal outcomes in a small fraction of cases.

Acute morphine and other opioid withdrawal proceeds through a number of stages. Other opioids differ in the intensity and length of each, and weak opioids and mixed agonist-antagonists may have acute withdrawal syndromes which do not reach the highest level. As commonly cited, they are:

Stage I: Six to fourteen hours after last dose: Drug craving, anxiety

Stage II: Fourteen to eighteen hours after last dose: Yawning, perspiration, lacrimation, crying, running nose, dysphoria, “yen sleep”

Stage III: Sixteen to twenty-four hours after last dose: Nose running like faucet and increase in other of the above, dilated pupils, piloerection (gooseflesh), muscle twitches, hot flashes, cold flashes, aching bones & muscles, anorexia (loss appetite for food) and the beginning of intestinal cramping.

Stage IV: Twenty-four to thirty-six hours after last dose: Increase in all of the above including severe cramping and involuntary leg movements (“kicking the habit”), loose stool, insomnia, elevation of blood pressure, moderate elevation in body temperature, increase in frequency of breathing and tidal volume, increased pulse, restlessness, nausea

Stage V: Thirty-six to seventy-two hours after last dose: Increase in the above, fetal position, vomiting, free and frequent liquid diarrhoea which sometimes can accelerate the time of passage of food from mouth to out of system to an hour or less, involuntary urination and ejaculation which is often painful, saturation of bedding materials with bodily fluids, weight loss of two to five kilos per 24 hours, increased WBC and other blood changes.

Stage VI: After completion of above: Recovery of appetite (“the chucks”), and normal bowel function, beginning of transition to post-acute and chronic symptoms which are mainly psychological but which may also include increased sensitivity to pain, hypertension, colitis or other gastrointestinal afflictions related to motility, and problems with weight control in either direction.

Some authorities give the above as grades zero to four, and others add chronic withdrawal as a seventh stage. Some separate post-acute and chronic withdrawal, others do not. For an example of the use of the above system, methadone clinics require, in the absence of a direct and documented referral from a doctor, Stage II withdrawal symptoms and/or recent needle marks and/or surrender of injecting equipment and/or unused drug at the intake appointment to begin the methadone maintenance or withdrawal process; two urine tests positive for opioids must then be collected shortly thereafter.

The withdrawal symptoms associated with morphine addiction are usually experienced shortly before the time of the next scheduled dose, sometimes within as early as a few hours (usually between 6–12 hours) after the last administration. Early symptoms include watery eyes, insomnia, diarrhea, runny nose, yawning, dysphoria, sweating and in some cases a strong drug craving. Severe headache, restlessness, irritability, loss of appetite, body aches, severe abdominal pain, nausea and vomiting, tremors, and even stronger and more intense drug craving appear as the syndrome progresses. Severe depression and vomiting are very common. During the acute withdrawal period systolic and diastolic blood pressure increase, usually beyond pre-morphine levels, and heart rate increases,[22] which could potentially cause a heart attack, blood clot, or stroke.

Chills or cold flashes with goose bumps (“cold turkey”) alternating with flushing (hot flashes), kicking movements of the legs (“kicking the habit”[23]) and excessive sweating are also characteristic symptoms.[24] Severe pains in the bones and muscles of the back and extremities occur, as do muscle spasms. At any point during this process, a suitable narcotic can be administered that will dramatically reverse the withdrawal symptoms. Major withdrawal symptoms peak between 48 and 96 hours after the last dose and subside after about 8 to 12 days. Sudden withdrawal by heavily dependent users who are in poor health is very rarely fatal. Morphine withdrawal is considered less dangerous than alcohol, barbiturate, or benzodiazepine withdrawal.

The psychological dependence associated with morphine addiction is complex and protracted. Long after the physical need for morphine has passed, the addict will usually continue to think and talk about the use of morphine (or other drugs) and feel strange or overwhelmed coping with daily activities without being under the influence of morphine. Psychological withdrawal from morphine is a very long and painful process.[26] Addicts often suffer severe depression, anxiety, insomnia, mood swings, amnesia (forgetfulness), low self-esteem, confusion, paranoia, and other psychological disorders. The psychological dependence on morphine can, and usually does, last a lifetime.[27] There is a high probability that relapse will occur after morphine withdrawal when neither the physical environment nor the behavioral motivators that contributed to the abuse have been altered. Testimony to morphine’s addictive and reinforcing nature is its relapse rate. Abusers of morphine (and heroin) have one of the highest relapse rates among all drug users.