Research:a common link between alcohol gambling, sex and drug addiction

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Brains wired for addiction By SAMEH FAHMY
Staff Writer

Researchers are finding similar biological roots for destructive behaviors involving alcohol, gambling, sex, drugs and food

Without alcohol, an addict can feel hopeless and full of despair. With it, the addict risks losing everything he holds dear.


Now read those sentences again, but substitute ''alcohol'' with the word ''gambling.'' Or maybe try substituting the words ''sex'' or ''heroin'' or ''food'' or ''cocaine.''


As far back as 20 years ago, researchers first started asserting that chemical and behavioral addictions are more alike than different. Now, with the help of technology that allows them to essentially peer into the brains of addicts, they're finding evidence to back up their claims.


There are skeptics, but proponents of a more unified view of addictions say it could open up new, more effective, ways to treat addictions while revolutionizing how science and society views addicts.


''It is very true that we're still in a beginning stage of the science,'' says Patrick Carnes, author of 10 books on addiction and a pioneer in the field of sex addiction. ''But we have enough clarity now, and that clarity is gaining momentum. And suddenly I think we're going to be on the other side of this where we're saying, 'I knew that all the time.' ''


Pleasure circuits shut down

Dr. Peter Martin is the director of the division of addiction medicine at Vanderbilt University Medical Center. He says that four or five years ago, he would have never equated a behavioral addiction with a drug addiction.
Then he began a study that used a technology known as functional MRI (fMRI) to see how the brains of people react to sexually arousing images. He found that when exposed to an arousing stimulus, the same parts of the brain involved in addiction to drugs such as cocaine, heroin and nicotine become active.


Further research has discovered that these ''pleasure circuits'' also are activated when people see or smell their favorite foods and when compulsive gamblers play games of chance.


''These are very basic mechanisms,'' Martin says. ''And if you want to understand what makes us tick — feel happy, sad, get from point A to point B, choose our daily activities and priorities — studying addictions will yield fundamental answers about what makes us who we are as individuals and as a society.''


The neurotransmitter dopamine works through these pleasure circuits to produce feelings of well being. What drugs such as cocaine, amphetamines, heroin and alcohol have in common is that they increase the concentration of dopamine to give users a high.


PET scans of addicts reveal that repeated drug use decreases the number of receptors in the brain that dopamine binds to. The decreased number of dopamine receptors has even been observed in obese people.
Without these receptors, the chemical can't relay its signal to brain cells. The result is that a person becomes tolerant to a drug so that they need more of it to get a high. This tolerance occurs in drug and alcohol addictions, but is also seen in compulsive gamblers and sex addicts.
Eventually, day-to-day pleasures like a fine meal or a smile don't produce the same feelings that they used to. At this point, addicts don't take a drug or engage in a destructive behavior to feel good. They do it to feel normal.


''When a person becomes an addict, it's no longer a party,'' Martin says. ''And that's what our society does not understand.''


To get a sense of how brain changes make addiction so destructive, imagine yourself as a radio-controlled model car, seeking positive experiences and avoiding negative ones.


Addictions, Martin says, are alike in that they rewire the brain, essentially hijacking the controls, to steer users toward a drug or behavior. The addict is no longer in control, and — without professional help — powerless to stop himself or herself from going off the edge of a cliff.


Susceptible to one, vulnerable to many

Researchers and therapists also are beginning to realize that addicts often are addicted to more than one behavior or substance. One study found that about half of compulsive gamblers are addicted to alcohol or other drugs. Carnes, who is executive director of a program called A Gentle Path at Pine Grove Behavioral Health and Addiction Services in Hattiesburg, Miss., found that nearly 90% of sex addicts have some other addiction.
Carnes argues these addictions don't just co-exist, but they also ''interact, reinforce and become part of one another.''


Carnes says that when treatment centers focus on the substance rather than the person and the underlying issue that led them to that substance, they make relapse much more likely. They also run the risk of snuffing out one addiction only to have the addict pick up another dangerous and destructive habit.


In a classic example, one of the co-founders of Alcoholics Anonymous was able to stop drinking, but then saw his compulsive sex and money problems spiral out of control.


Because the new science of addiction is revealing similar biological roots of addictions, people such as Carnes are arguing that treatment for different types of addictions should be similar, too.


At Pine Grove, people are treated for chemical addictions to alcohol or drugs as well as for sex addiction and personality disorders.


Carnes says it shouldn't be a surprise that the pioneering 12-step Alcoholics Anonymous program has since been replicated to create groups such as Sex Addicts Anonymous, Overeaters Anonymous, Gamblers Anonymous, Shoplifters Anonymous and Debtors Anonymous.


A more unified view of addictions has implications for treatments with medications, too. Researchers now are looking for drugs to repair the addict's defective pleasure circuits.


Last year, scientists funded by the National Institute on Drug Abuse created a synthetic chemical that regulates the way anandamide, a natural marijuana-like compound in the brain's pleasure circuit, is processed. Tests on mice have shown that the experimental compound kept the anandamide in the brain longer, much in the same way Prozac inhibits the uptake of neurotransmitter serotonin to ease symptoms of depression.


One definition doesn't suit all

The consensus among researchers is that behavioral addictions, most notably gambling, do exist. Still, some say that lumping all addictions together is simplistic and premature.


Nancy Petry, a professor of psychiatry at the University of Connecticut Health Center, says we still don't know enough about how the brain works to know the full implications of brain imaging studies. And although many people do have co-occurring addictions, the phenomenon isn't universal.
Petry agrees that some addictions do have similarities, but questions whether people with behavioral and chemical addictions would feel comfortable being treated at the same center.


She also cautions against defining addictions too loosely.
''If you go to the far extreme then anything can become an addiction,'' she says. ''And I think that's really an inappropriate way to view it because really minimizes what's an addiction and what's really a psychiatric problem in a broader sense.''


She points out that some people watch so much TV that it hurts their social and family life. They may develop problems in work or school, and — given the sedentary nature of watching TV — can end up with serious health problems.


If we start to call this an addiction, she asks, then aren't we absolving the individual of his or her responsibility?
Proponents of a more universal view of addictions say they've seen how addictions ruin lives, and have no interest in minimizing them. They say it's time for society to view addictions as medical problems rather than moral ones.


''These are not sins,'' Martin says. ''This is an illness.''


Where to find help

People with behavioral or chemical addictions can seek help at one of several support groups based on the 12-step model pioneered by Alcoholics Anonymous, which was founded in 1935.
Groups without phone numbers listed have multiple contacts; see the Web sites for the group closest to you.
• Alcoholics Anonymous (Middle Tennessee central office), www.aanashville.org, 831-1050
• Al-anon (for families of alcoholics), www.middletnalanon.org, 333-6066
• Cocaine Anonymous, www.ca.org, 747-5483
• Crystal Meth Anonymous, www.crystalmeth.org
• Debtors Anonymous, www.debtorsanonymous.org, 269-3628
• Dual Recovery Anonymous (for people with substance abuse and a psychiatric diagnosis), www.draonline.org
• Gamblers Anonymous, www.gamblersanonymous.org, 254-6454
• Narcotics Anonymous, www.nanashville.org
• Nicotine Anonymous, www.nicotine-anonymous.org
• Sexaholics Anonymous, www.sa.org, 251-7516
• Overeaters Anonymous, www.oa.org




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