Dr. Jack Wang has been doing some interesting work studying what’s going on in the brains of those who have compulsive cravings. He shows that a pattern of behavior that triggers a disproportionate feeling of satisfaction or reward leads the brain to dampen the neurological effect of the habit, leading to a desire for more.
Dopamine surges make us want to repeat important human behaviors such as eating and having sex.
“Imagine what a strong hold these hijacked reward pathways take on our brains and our whole existence when they’re so closely connected, geographically and anatomically speaking, with our memories and our emotions,” says Petros Levounis, MD, director of the Addiction Institute of New York at St. Luke’s and Roosevelt Hospitals in Manhattan.
In an unhealthy habit, the dopamine surges become too much for the normal inhibitory control of the brain’s frontal lobes to damp down.
“Ultimately,” Levounis says, “the war on drugs is a war between the hijacked reward pathways that push the person to want to use, and the frontal lobes, which try to keep the beast at bay. That is the essence of addiction.”
Dr. Jack Wang, MD, of Brookhaven National Laboratory on New York’s Long Island, has conducted several brain imaging studies of obese patients using PET-CT scans.
In both drug-addicted and obese patients, brain scans show a lack of dopamine receptors, a result of the prior dopamine overload.
“If a person constantly has an excess of dopamine, the brain will down-regulate,” Wang says, “Once the system is down-regulated, we have to do more in order to get the same amount of feeling in our normal state.”
Wang and his colleagues have also shown that a higher body mass index (BMI) correlated with lower prefrontal cortex function — the area associated with inhibitory control.
“If they’re obese,” Wang said, “they have a problem controlling their eating behaviors.”
The idea of medications that act on the dopamine system is “to cool down those reward pathways,” Levounis says. There are two strategies for doing so: an agonist strategy, or an antagonist strategy.
The agonist strategy is “feeding the beast, providing activity in the cell so that the cravings go down,” Levounis said (such as nicotine patches, or methadone for opioid dependence.)
The antagonist strategy aims to block the receptors. Naltrexone, for example, blocks opioid receptors so that the drug addict won’t feel anything if he or she attempts to get high.
“After a while, you say, ‘This is not worth my time, my money, my trouble,’ so you stop using,” Levounis explains.
So far, these have been the two main strategies in addiction pharmacotherapy, but there’s now a “third avenue” — the partial agonist approach.
In the partial agonist approach, one molecule blocks most receptors while still providing helping to calm cravings.
This leaves the question of boosting inhibitory control.
Psychiatrists will try to “cool down” the reward pathways, often with medication. Then, they target the diminished frontal lobes with psychotherapy.
“We try to beef up the frontal lobes as much as we can, and we do that with psychotherapy,” Levounis said.
Researchers agree that psychotherapy is key to regaining self-control, and it’s the predominant treatment used in patients with addictive behaviors.
Mark Smaller, PhD, a psychoanalyst in private practice in Chicago, said psychotherapy often reveals an underlying cause for an addiction or compulsive behavior. Usually, it’s anxiety or depression.
Acknowledging those problems may help change behaviors. Once they’re realized, a patient can start working against them, with the help of the brain’s own neuroplasticity. Essentially, neurons can disconnect and reconnect, or loosen their connections and tighten them, which often manifests in noticeable change.
“[Psychological] insights can actually begin to change brain chemistry and diffuse compulsions,” he said. “If you address those issues, you can have a positive impact on your life that can change the chemistry of your brain.”
***I would add that some Mind Sparke customers have found that dual n-back training can help boost the frontal lobes and assist with compulsion control.***
See the article used as the source of this post in “MedPageToday“